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W <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />PUBLIC WORKS <br />EVERETT. WASHINGTON <br />Type or print clearly with Ink <br />PFILSS HARD - YOU ARE MAKING COPIES <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY:-�?-"c C' <br />PERMIT NO.��- <br />HEREBY APPLIES FOR PERMISSION TO .1l - / �� � �7��h '�'tnc f �Ic � ed�n c O •� 3, df 't::t�K <br />,/�i <br />q n /s s /.�.1 0 8 �c k ri d y S 1 r �' .'.,T .::-r/y d <br />AT THE FOLLOWING LOCATION '?60 4Je'/p rT /�y f '-,T eref 'fi(r t _L 411- <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />'liner C <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 />LOMM ICATIONS <br />TRAEDL <br />PLANNING <br />Ike gK710P <br />APPROVED AS CONSTRUCTED DATE <br />( ij:; i _ . ,i_Ii <br />g'/,a.6ce;, /c_r:io*1+ <br />s ( <br />c) // s ideo-r +Ae. 1� erpll <br />DRIVEWAY SECTION <br />jl' LIP <br />I ��" <br />30�I <br />r 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 />ea penses. or causes of action that may arise because of installation <br />and maintenance OI the improvement Or other right-obway use <br />lie, elo applied for and further agrees to remove same upon notice <br />from the City and to replace public Properly damaged thereby <br />SiGNAI URE-r LICANI 0, <br />-•i <br />a ss <br />City IiP <br />�2.r --0 2 ?I��y s o s <br />it LEPHONE NUMR RLrERNAII <br />❑AlE/ <br />1978 <br />