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19 <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly With ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS r <br />EVERETT. WASHINGTON <br />PERMIT NO._SO `I (& <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY/�_'n,' - / <br />HEREBY APPLIES FOR PERMISSION TO._Yl(y��� � ✓� �� Q� I _eo) <br />T <br />AT THE FOLLOWING LOCATION B - (0 3 —7; .?E, I`// r ear %% Aldr <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />* A-6' <br />*4, �-1x1tfz- 6 obi elm Orl 5&egl-b" . -qe o �i dr9 Tia v azl <br />C'i9�L�HBh'S/� C7fE".9T��i� ro <br />F /46 <br />/itl L�,BGlG� ,e/¢HT of Gt//QY TU ,Bc` �SUiTi9,&« �?Hi.E.ei/t'G <br />0AJoV,etid V "Mill <br />G'�Pr�shy�� S��FiPel2�lz <br />�'` AFT.E.e CO/lY%>GFj�5��7l.F/%/11 T di='i/.� /l?i9T.�.eifiG5 <br />'9.PIVII C/�N)T 4Si��e,� T a1,9T2elr 5.Y.91� eF oee4- dited� <br />00fi- A 9,e�i?s <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-991 1 <br />24 HOURS BEFORE CONSTRUCTION <br />EIVT APPROVALS <br />J <br />DRIVEWAY SECTION <br />LIP �1 <br />The undersigned owner hereby agrees to hold and Sava harmless <br />the City of Everett from any and all claims for damages.' cools, <br />ea pensesor causes of action that may arise because of installation <br />and maintenance of The Improvement or other Hghl-ol-way use <br />healo applied for and further agrees to remove same upon notice <br />Irom the City and to replace public property damaged thereby. <br />SIG AZURE API`( �. Te,y� <br />s AD SS <br />CITY III7 lIP <br />3.-fio 9 fl <br />TELEPHONE NUMOCR AL ERNAIE <br />DATE <br />CONSTRUCTION/AS BUILT EE 1978 <br />