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everen ' <br />Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />�j Type or print clearly with Ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT. WASHINGTON PERMIT NO. y— <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: `' f o' S <br />HEREBY APPLIES FOR PERMISSION TO --CLU c) Z fuI LL^7/. )(— te-L'I C p21 V E w <br />AT THE FOLLOWING LOCATION <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />pet" p/rAr s aryrovej- rk' -aa cA 51171;7Y <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 />V1ENT <br />M <br />DRIVEWAY SECTION <br />LI \ jl" LIP <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 use <br />hereto applied for and further agrees to remove same upon notice <br />from the Gty and to:eplace publlc property damaged thereby <br />v. <br />IGNATURE OF APPLIC <br />O <br />AODRE55 <br />DA <br />TELEPHONE NUMBER ALTERNATE <br />—3 - 7i <br />DATE DAiE <br />CONSTRUCTION/AS BUILT <br />