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y <br />t A� <br />Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />VType or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES - A <br />PUBLIC WORKS q <br />EVERETT. WASHINGTON PERMIT <br />GeOr� C. C1% <br />APPLICANT (UtJDEP;iGNED) AND FIRM REPRESENTED. IF ANY. r/al ��[ Cila•�..f <br />HEREBY APPLIES FOR PERMISSION TOY,/Fl, Cl/re c t Sjr wj id <br />AT THE FOLLOWING LOCATION `T UWf k/c Tin d rr qv or. ZrA� <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />At+►EuuEu 5/ai/79 <br />SK6Tc4. <br />N <br />b <br />gMEA-it�,o�ur <br />rC <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 />APP I OR CON ST U T DN��^ <br />(/� <br />AFFHOVED AS CONSTRUCTED o„E <br />REFERENCECOPY <br />iliac rc7 CTlrr ar.aY1 4,,% <br />7Fde !fa> 3C'C4. <br />:a <br />-'d <br />DRIVEWAY SECTION <br />I ( I" LIP <br />O,r T <br />The undersigned owner hereby agrees to hole and Sava tuinwhiSS <br />the City of Everett from any and all claims for damages, vests. <br />espenses. or causes of action that may arise becauu of installation i <br />and maintenance of the improvement or other right-of-way use <br />hereto applied for and further agrees to remove same upon notice <br />from the City and ro replace public property damaged thereby. <br />AD 5S <br />-0Uer� _ <br />ury zip <br />Sf o77� ALTERANATENATC <br />s�S <br />TELEPN NE NUMB <br />paiE ram) <br />t_ <br />_ I <br />rEE <br />