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everett <br />APPLICATION FOR RIGHT-bF-WAY USE PERMIT <br />Type or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS EVERETT, WASHINGTON PERMIT NO. n� T <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: L A k l Fl�4 Iv,4L &xto1 <br />HEREBY APPLIES FOR PERMISSION TO C ONS rA ve r 2.S F Ij R I v CWA k <br />AT THE FOLLOWING LOCATION <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />7 1 5 T -S T /lrh r <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 />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />/�" 7 <br />APPROVED FOR CONSTRU C T14r DATE" <br />Ap'lis" <br />APIOVED A CONSTRUCTED DATE <br />DRIVEWAY SECTION <br />I" LIP <br />�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 further agrees to remove same upon notice <br />from the City and to replace public property damaged thereby. <br />' A ", <br />SIGNATURE OF APPLICANT <br />2- 13 L Id rC ry L,aL-d <br />ADDRESS <br />CVF-nfrr <br />CITY LIP <br />252.-1ySo <br />TELEPHONE NUMBER ALTERNATE <br />: It 1p FEE 78 <br />CONSTRUCTION/AS BUILT <br />