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ki <br />APPLICATION FOR RIGHT -OF WAY USE (PERMIT <br />Typn or print Denny with ink <br />PRESS HARD - Y01I ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT. WASHINGTON PERMIT NO._ <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY: -- <br />HEREBY APPLIES FOR PERMISSION TO �OR/.ty-At�T �3 y 1Jna/1/LFC(J�`!�_ <br />AT THE FOLLOWING LOCATION <br />DRAWING (WORK (WOR� BE DONE) OR PLANS ATTACHED: <br />2 �?���. <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR IIIIIISPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWFn <br />DRAINAGE <br />WATER <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />PANNING <br />v. <br />A PRP OVER FOR CO S TION r DATE <br />DRIVEWAY SECTION <br />j I" LIP <br />�30" <br />the, undefMgned owner hereby agrees to hold and save harmless <br />Pw City of Everett from any and all claims for damages, costs. <br />- •pemrs, ur Causes of action that may ante because of Installation <br />Pat mo 0enence of •ne Improvement or other Rghhof-way use <br />f)wvtd appbed lot and hlnher agrees to remove some upon notice <br />hom the City and to rc dace public property damaged thereby. <br />Z <br />/ 51GNATURF Or APPLIUNI � <br />f'o Ptak y!y _ <br />ADDRESS / Q <br />CITY ZIP <br />Lam% y <br />I L I E I'HGNE NUMI t AI-LTIN AfE <br />TPPT±OVED AS EONSTFUCTED <br />irF 1978 <br />