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rverelf <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />T yo pnnl clearly with ink <br />PRESS HARD YOU ARE MAKING COPIES <br />PUBLIC WORKS /- <br />EVERETT, W ASHINGTON PERMIT NO. <br />APPLICANT IUNDERSIGNEDI AND FIRM REPRESENTL-.D. IF ANY. •SAP. Ie 5";?-P 7 W L[J/Ls /1/e,_ <br />HEREBY APPLIES FOR PERMISSION TO ( OniS Ti i U6/_ ez,3 / dwh--/(f( <br />AT THE FOLLOWING LOCATION _�"'�� ' <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 />SEWER <br />DEPARTMENT APPROVALS <br />DRAINAGE <br />WATER -- <br />51RETT <br />COMMUNZA T iGNb <br />PLANNINII <br />Y <br />`°01 <br />� Izi� <br />A ROV—TT— ED AS CoWsf tTcTED DATE <br />DRIVEWAY SECTION <br />I � 11" LIP <br />30�_ 130•' <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett from any and ell claims for damages, costs. <br />tV Tenses. or causes of action that may aloe because Of installation <br />imd mamlenance of The improvement or other nghLobway use <br />thereto applied lot and further agrees to remove some upon notice <br />IrBM the CITY And to replace pilot., properly damaged Thereby. <br />/V <br />STUN- 1(,' 1, ')E AOrliGryr 7 <br />a ,CTex iip <br />ADDRESS ^ <br />�i/2/r.<Nw1� Gvy 9�d�,3 <br />CITv d <br />TELERHtIE NUMBER ALTERNATE <br />DAi[ <br />REFEHENCL'COPY <br />