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1 <br />eve en <br />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. <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: "� AQL A'-Z M.9 �✓ <br />HEREBY APPLIES FOR PERMISSION TO gtl/GU 9 111E-(-T / D 7//E Ek/ST/iVG <br />�/OUSE <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 INSPECTIOri 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />SEWER {, nv COMMUNICATIONS <br />\� <br />DRAINAGE C TRAFFIC <br />WATER ``,`� r•�� ' PLANNING <br />SIRE 4; <br />APPROVEDF CONS HuL; N bATE <br />APPROVED AS CCNSTRUCTED DATE <br />DRIVEWAY SECTION <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 />e.pep;as. or causes of action that may arise because of installation <br />an.. mamtengnce of the improvement or other right -of -Willy use <br />hereto appliedfor and further agrees to remove same upon notice <br />from the City and to replace public property damaged thereby. <br />i <br />SIGNATURE OF APPLICANT <br />`J �:Z 3 �OGfiEfELL ErC� Nt/t . <br />AD DR SS <br />CITY <br />✓-s>- is/Z 342-4aoq <br />TELEPHON NUMDER IL ALTERNATE <br />DATE / <br />REFERENCE COPY rEE 1978 <br />17 ..— - - <br />