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everett <br />APPLICATION FOR RI�HT-OF-WAY 11SE PERMII' <br />� TYPe or Print clearly with ink <br />PRESS HARD -�rU� ARE MAKING COPIES G <br />PUBLIC WORKS PERMIT NO. � �--/� �O <br />EVERETT, WASHINGTON � A �2 _ <br />APPLICANT (UNDERSIGNED) AND FIRNi REPRESENTED, IF ANY: <br />� <br />HEREBV APPLIES FOR PERMISSION TOy��� ` � <br />AT THE FOLLOWING LOCATION <br />g�� TH ,a v� , GU, <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />� �Q- / c u�' �, � u i rc �'. `� �` � i/tJ � ���N�z, 5'� D� u�ir'G� <br />�`- .F"f'c�� a� ��1�,� %U ,6� h'T /S�.�iP�/�1 � <br />� s�"i��d5f1�D �/�1 s�"�-Trati T� �'� Gl �s.� A.A� � <br />PERMIT IS VALID POPi 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CQ►LL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />APVROVEDASCONSTRUCTEO <br />G.�IE <br />� 11 : �, <br />� i.. <br />SECTION <br />i _---- <br />� I" LIP <br />���„ I �30 <br />The unCersigned owner hereby a9ree� to hold ana save harmless <br />the City o� Everett Imm any and all claims lor dama9es. costs. <br />expenses. or causes ol aclion that may anse because ol installation <br />� �aiNena�ce ol lhe �mprovemen� or O�hei n9hPOb�+'aY u5e <br />`'p applied b� antl lurther a9�ees lo remove same upon no�ice <br />�� �I �e Ciry antl lo replacc publ¢ pmp�riy aa�+ayed Ihereby. <br />U <br />C j .., 1.,19 <br />0.` _..�����i <br />^{l -' � on � �� �`cl--��� �d� <br />"'vylt SIGNAi RE OF �i'PLICPNT <br />//G6�/ crG.�l4 'c._��L�-- <br />noor+ess <br />_�����"� �� �dv33 <br />��r� <br />ZP <br />< 6 ~ hLTFRNAlE <br />TELEP�iONE NUM�ER <br />CCi'lE� I i'�UCI �Cipl:'.",ti i�UIL I <br />