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everlett <br />Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />�/ Type or print clearly with Ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT. WASHINGTON PERMIT NO. 2'-4 <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY:_ <br />/ <br />HEREBY APPLIES FOR PERMISSION TO Z/z' -�- ( it-yFi /�(�YwrGGri'a�c.. <br />AT THE FOLLOWING LOCATION ! V I0 642,4/V r O„ IyC= y 5ile RL Try OJ4.1 <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 />r <br />APPROVEDF CON TRUCTION DAB <br />APPR,?,NEWS CONSTRUCTED DATE I — <br />CONSTRUCTION/AS QUILT <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 right-of-way use <br />hereto applied for and further agrees to remove same upon notice <br />tidlnithe City and to replace publ¢ property damaged thereby. <br />- 1 ' \1 <br />SIGNATURE OF APPLICANT <br />o:G Avr <br />ADDRESS <br />5Y,9-i5cE-?-7- <br />CITY �%r%4 • G �s2y 3 _ <br />ZIP <br />35'3 - l 3 IP? <br />TELEPHONE NUMBER ALTERNATE <br />FEE 1978 <br />