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everetl <br />Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />VType or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT, WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY: <br />�LPERMIT NO, <br />C. 0'fi sit <br />HEREBY APPLIES FOR PERMISSION TO .JG•.� y� `lvf /I TEme e f��as Cds� c S. d a wd� <br />36a/ /7 ! r.20 .E nza n •�Y! "'% r r .oM oevry <br />AT THE FOLLOWING LOCATIONt1/ I ont prr 'i _ ✓e-' 5A ('ry'7.4r (rtirt" jG <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />41 <br />VI <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR I/4SPEECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />AFIPReVYD FOR COa1U1tJ IlA <br />APPROVED AS CONSTRUCTED DATE <br />CONSTRUCTION/AS BUILT <br />3'h;) (Ileh /C 4/ T'-t On p lyu�c/ <br />Ci// S/! 0-(r/IC. 1 r` // <br />DRIVEWAY SECTION <br />LIF <br />�30"_ I <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of E.erett from any and all claims for damages. costs. <br />e'penses. or causes of action that may arise because of installation <br />and maintenance of the Improvement or other ighl•ol-way 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 />iv <br />cl�S <br />TELE'PHpNE NU`Ma ALTERNATE <br />L <br />ATE' <br />