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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type Or print clearly With inkeverctt <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT. WASHINGTON iT PERMIT NO. / 3 <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED IF ANY: <br />HEREBY APPLIES FOR PERM <br />rd <br />AT THE FOLLOWING LOCATION <br />DRAWING (WORK TO BE/DONE) OR THREE PLANS ATTACHED: / / <br />�� l f/<� G !`O✓ S le? /? O /7 el I/ <br />rL S7 r-P P L✓��"ov` //�r%2Pi✓ <br />Al Urinr7a1h7 <br />er <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 239-6B1 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />LI SEWER COMMUNICATIONS <br />DRAINAGE <br />WATER <br />TRAFFIC <br />STREET <br />-APPROVED U 1 ATE <br />APPROVED AS GONMOCTED DATE <br />M, a, <br />DRIVEWAY SECTION <br />f I" LIP <br />The undersigned owner hereby agrees to hold and sere harmless <br />the City of Everett from any and all claims for damages. coats, <br />e s penses. or causes of action that may arise because of installation <br />end maintenance of the improvement or other right-ol-way use <br />hereto applied for and further agrees to femov I, same upon notice <br />Irom the City and to replace public property damaged thereby. <br />SIGNATURE OF APPLICANT <br />AGGTIE' <br />Gj :i'P G <br />lEE 0LNU�?- a RN3a It/ <br />4 Z /Q/ <br />CONSTRUCTION/AS BUILT <br />1978 <br />