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everrM <br />Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />�j Type or print clearly with Ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT, WASHINGTON PERMIT NO. <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY:—I—yUl 5 (Lt " 1 4 R 50 <br />HEREBY APPLIES FOR PERMISSION TO <br />AT THE FOLLOWING LOCATION 1 3 (19 iv r 1, I V �' i GV e R c T r, 6J4 ,, c7cir'ZO 3 <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />DRAINAGE <br />WATER <br />STREET <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />APPROVnO l-Lr UUPI r II Fi- TON f DAB <br />DRIVEWAY SECTION <br />+I LIP <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, costs. <br />expenses. or causes of action that may arise because of installation <br />and maintenance of the Improvement or other tight -of -way use <br />hereto applied for and further agrees to remove same upon notice <br />f16rnnthe City and to replace public property damaged thereby. <br />SIGNATURE Of APPL ICANI <br />�!10Aa'j'V-E-2&- <br />ADDRESS <br />G Ur-Rr i T _,/� • 9 �2d 3 <br />CITY ZIP <br />35-3-IF3F8 <br />TELEPHONE NUMBER ALTERNATE <br />