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APPLICATION FOF�(RIGHT-O -WAY USE PERMIT <br />Type or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS 7( — 27 7 <br />EVERETT. WASHINGTON PERMIT N ._ <br />APPLICANT (UNDERSIGNED) AND FIRM�;R€SEN_T_ Y,)F ANY��6A �+',��t/ c e ( I r67S if,T. <br />HEREBY APPLIES FOR PERMISSION TOS <br />L(;(l �/ <br />AT THE FOLLOWING LOCATION <br />11C ; <br />do LJC7N6k& f1J6feNv F <br />( 4C� 5NJ;1AA1 L, <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />L1,111 <br />Pc�t� c"nId, q(S oN. �acP <br />S a�Su S fJ (PcT `ta ✓e✓ cc i'n a�o <br />pe.nx <br />J V <br />��u4 II/e✓ # <br />a s <br />�e� S{4�i l,ve l ,�tc a Qcr��i�9 1 <br />J j <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-691 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />SEWER COMAIUNI�S <br />DRAINAEt TRAFFIC <br />WATER PLANNING <br />ST&EE /P FOR C TRUCTI O E <br />AP ROVED AS CONSTRUCTED DATE <br />REFERENCE COPY <br />DRIVEWAY SECTION <br />I LIP <br />I 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 -way lee <br />hereto applied for and further agrees to remove same upon notice <br />from the City and to replace public property damaged thereby. <br />iIyj <br />SIGNATURE Or APPLICANT <br />uTv ZIP <br />TEt EPIIONE NUMBER <br />ALTERNATE( <br />