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evereM <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with in <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT. WASHINGTON PERMIT NO. <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: /'\ / rl le <br />HEREBY APPLIES FOR PERMISSION <br />AT THE FOLLOWING LOCATION /-O / O'7ir {/,-Q SAn r/ <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />/,/. ,.rAl / T <br />f a4' /f 2-2-, V p/c /UDiy%iS <br />0A"100y-10- clCcQS� and T Q46,,,� <br />7 <br />of (/of . a� !"��4-1 1�1(vd 62fwQey,' <br />6�eivvc�o� X /2Q kn 'v 0.c, r,, in rd f <br />01- <br />IZc noL�1� a K�L ae�rc� �T o„a�z� ZAt� <br />O Csv> �A11_ �v a� ��l►lSTA2J_�� <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 />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />'1 <br />PLANNING <br />a S 938 <br />APPROVED FOR CONSTRUCTION DATE <br />APPROVED AS CONSTRUCTED DATE <br />CONSTRUCTION/AS BUILT <br />DRIVEWAY SECTION <br />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-obway 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 />/ '�lxl <br />SIGNATURE OF APPLIL <br />6/ S !/ f�(O/v t 1'�9 A Dr, <br />ADDRE V r 0 / / ^,} 2-C j3 <br />CITY ZIP <br />3r 3 -Z/K�- <br />TELEPHONE NUMBER ALTERNATE <br />DATE <br />