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!V!rl11 ' <br />APPa-(CATION FOR RIGHT-OF-WAY USE PER►AIT <br />Type or print clearly with Ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS PERMIT NO.ri`_I— <br />EVERF.TT, WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: V <br />HEREBY APPLIES FOR PERMISSION TO <br />Ca to (zJE�-c -r I Cwj <br />AT THE FOLLOWING LOCATION O V F 1�JflQ /E ie <br />/33 <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: ' <br />r�- <br />��,y <br />PERMIT IS VALID FOR 160 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 />DRAINAGE <br />WATER <br />CTGFFT <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />DRIVEWAY SECTION <br />I" LIP <br />�30i1 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-ol-way use <br />hereto applied for and lurther agrees to remove same upon notice <br />from the City and to replace public properly damaged thereby. <br />Fo`z ki IGI t� <br />�— <br />KSLr(a55CC.IN( . <br />51 tJAI'URE OF APPI T <br />9aCi 4n /aVir <br />ADDRESS <br />'SEAT-( E� <br />�i�dlo4 <br />CITY <br />21P <br />(p22 - Qj2dS <br />TELEPHONE NUMBER <br />ALTERNATE <br />DATE <br />CONSTRUCTION/AS BUILT <br />78 <br />