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r <br />!YIln11 <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 <br />PERMIT NO. 7 9 Z E 3 <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED,IF ANY:j"IQIl.IQ1li TTF� �Wjr=kIL <br />HEREBY APPLIES FOR PERMISSION TO �pww;%-s ctr- I -I f 04T4 lciT 1t.1 V6W A:c-? _ <br />AT THE FOLLOWING LOCATION <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 959-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />STREET <br />AI'V111111LIVItu rum C N UCTIO <br />—ell <br />r 'ROVED AS CONST Rl1CT _ n <br />DRIVEWAY SECTION <br />LIP <br />�1�30 � <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-aey use <br />hereto applied for and furthar agrees to remove same upon notice <br />from the City and to replice public property damaged thereby. <br />SIGNA O" APPLICANT <br />App IJESS <br />�32—S7h� —L19G8 <br />TELEPHONE NUMBER .�.\LTERNATE <br />DAIC LE r11L� _ oti. <br />1 <br />