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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />0 Type or print cledrly wllh .nk <br />PUBLIC WORKS <br />PRESS HARD - YOU ARE MAKING COPIES .6 5 <br />EVERETT. WASHINGTON 7Q/ <br />PERMIT NO. _ / <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY '" 1<% _x GCJ /L�/�it/.,S /A.) v <br />HEREBY APPLIES FOR PERMISSION TO__. I d VC 7-7i V Gi/ �,3 / O4 i✓='�,y,�� <br />AT THE FOLLOWING LOCATION — / "t'j_]� - - <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE, <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />6EWER <br />DRMNAGE <br />WAfER <br />!TFEE� <br />DEPARTMENT APPROVALS <br />40MMUNiCAtIUNS --- <br />PLANNING <br />pATF <br />D FUN CONSII ION v 1 <br />ROV DASCONSIRUCTED — <br />Ilia I-i I,_''1C1_LL'(•'.,ir <br />DRIVEWAY SECTION <br />I" LIP <br />The undersigned owner hereby agrees to hold and save harmless <br />me City of Everett from any and all CIAIMS for damages. costs. <br />er penses 01 ca Jet Of action that may nine because Of mstallah00 <br />end mamlenanco of the Improvement m other nght-of-way use <br />hrvet0 applied for and further agrees 10 remove same upon notice <br />tom Ill" City and to replace Public VIOPaly damaged Ihelebt <br />SIGNATURE Of Annl¢AHT <br />LITV <br />lln <br />TELEV-UI r1t0.1111111 l� at UANArI <br />E-- - -- - -- t98 <br />