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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with Ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS "If �31 <br />EVERETT. WASHINGTON PERMIT NO. T <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY !' /LJ �V L�-J` <br />HEREBY APPLIES <br />AT THE FOLLOWING LOCATION <br />M <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED. <br />�L"KM 1 i 1� Z u 3 j-CCT <br />�I�p�2ovewte�T �3`� e��R�T <br />w(rq (52t7�1U�lJCC SSS-�S <br />ge <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSII E. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFOR: CONSTRUCTION <br />DEPARTMENT APPROVALS <br />SEWER <br />DRAINAGE <br />WATER <br />•••r • FOR CONSTRUCTION - <br />COMMUNICAliONS <br />PLANNING <br />APPROVED AS CONSTRUCTED DATE <br />f?0 is <br />1� 0 2 <br />CcatPic)rVe <br />( 'x 5 irre i rwviouew.e,,.-f <br />DRIVEWAY SE TION a <br />3s� AHu�Cyrc/wti <br />30'��� •� 30'�'I <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 />e•penes. or causes of action that may arise because of installation <br />and maintenance Of the Improvemenl or other right obway use <br />hemlo applied for and further agrees to remove same upon notice <br />I rom the City fund to replace public properly damaged thereby. <br />`$IDN. Un! ll nl Vrl <br />ADDRESS <br />MUI; 0&--49-4� J/� <br />Cwiled •' ZIP <br />L• ply- NE NUMBER ALTERNATE <br />CONSTRUCTION/AS BUILT <br />