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L <br />CVI`Lrfl <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />T, pit ul print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT. WASHINGTON PERMIT NO, 79 Z90 <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: ! ,& %/ �I /-' t]"J(' ^'(/� I) E fondsT. <br />HEREBY APPLIES FOR PERMISSION TO �iL� .-/f�Gl f'� �? F f7 /0*L7 <br />AT THE FOLLOWING LOCATION _. _. 1' / / Gr r /yn A L/c- <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />�a Ace] <br />1(ego <br />�-"mot be <br />vi Il <br />re °I'A" �o"�- <br />0 <br />er5 <br />IGSNeA <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 />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TPAFFIC <br />PLANNING <br />STREET y- — ---_ <br />APFOR CONS RU ON —E <br />APPROVED AS ONSTA TCTE-OD ATE <br />bx- l V'Fk{)i�k <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 becauso of installation <br />and mamtenance of the improvement or other right-ol-way use <br />hereto applied for and further agrees to remove same upon notice <br />from the City and to replace public property damaged thereby. <br />SIGNArURE OF APPLICANT <br />��rwy' d8 <br />ADDRESS L <br />CITY p <br />� LIP <br />C. 1 c `� �- p�TEgNAr• <br />TELEPHONE NUMBER <br />;//1/// <br />DATE <br />CONSTRUCTION/AS BUILT <br />1978 <br />