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nd <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Typn or print -learly with Ink <br />PRESS HARD - YOU ARE MAKING :COPIES <br />PUBLIC WORKS <br />PERMIT NO. <br />EVERETT, WASHINGTON / <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: "� H%�L ��SA-;19 ,I -- — — <br />HEREBY APPLIES FOR PERMISSION TO 5y1G0 �,q / TAl,-kI� 70 71/, 5k���T/NG_ <br />H/0USF _ <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 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />SEWER COMMUNICATIONS <br />DRAINAGE ^ C:) TRAFFIC <br />WATER rM, ;PLANNING <br />:.'Jl O <br />SIRE <br />, 7- <br />APPROVEDF CONS RUCTION ATE <br />APPROVED AS CONSTRUCTED DATE <br />DRIVEWAY SECTION <br />I" LIP <br />�- 0�130-'1 <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 orotherright-of-wp 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 />SIGNATURE OF APPLICANT <br />ADDR SS <br />3sS-/S/Z 342-40�f' <br />TELEPHONY, NUMBER / �D ALTERNATE - <br />DATE <br />REFERENCE COPY FEE 1978 <br />