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U APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS PERMIT NO. <br />EVERETT, WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY: ) t5wJfa. rpfy1wT_Go' <br />HEREBY APPLIES FOR PERMISSION TO 2z T {�—,PPCA!. Ty4-1 <br />I NI P a0 J( &-,1EA >t! I >r <br />AT THE FOLLOWING LOCATION 709 eqd T ~ S t_— <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />-/ C,41'eeEC u-rr-I-- <br />/'Il�c/�1Lrit/J' "MY Cyl/,eA('//Ut - <br />V If b.E I.Z L�PfI/Ill i'/!- " flLc.tk 8 y.51. 5� f:�L.[./ TfIG�" <br />tfkb TYP,� /-� 0grcly�issllu "7 �yLc r c7a7cE <br />I, <br />i0 rfXA)s17 <br />1�i1°DP�.L' TY 1-111K <br />IS VALID FOR 60 DAVS <br />COPY OF THIS APPLICATION TO BE P0511 <br />ON JOBSITE. <br />CALL FOR INSPF.CTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />�!IEE7 <br />+I" LIP <br />30" 1 30 <br />The undersigned owner hereby agrees to hold and as" harmless <br />The City of Everett from any and all claims for damagss. cost$. <br />expenses. or causes of action that may arise because of installation <br />and me.ntenance of the improvement or other light -of -way use <br />hereto applied for and funher agrees to remove same upon notice <br />from the City and to replace public property damaged thereby. <br />ZIP <br />` <br />j S5- /7oa <br />lEtEPHONE NUMBER ALTERNATE <br />�?-?/ - 22 <br />[WF <br />