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i <br />everell <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print cMarly with ma <br />Li PRESS HARD - YOU ARE MAKING COPICS <br />PUBLIC WORKS <br />EVERETT, WASHINGI.ON PERMIT NO. <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY -___ ----- <br />i .tom <br />HEREBY APPLIES FOR PERMISSION TO �- � zte <br />AT THE FOLLOWING LOCATION—._ 8 �� r �/ f <br />are c. ,re__AA� M+��qr w�erY <br />a•,� fi)a ..-a se. da_. Jo <br />//�� �.,--tenn c�L��.,' o.... �i-. w'I%. �_ 416 <br />ce rewQ.I -`0'' (•c-flace✓ �.. ♦�" \ —IIAL L1.1L'; <br />Sr,`oe cr alr,1n.C4Fa <br />"Lo'_ ew <br />ALP <br />..`Y�1ie✓ <br />�t• <br />a.. <br />I, Cr w ,. ) R.o? N, "\ <br />PERMIT IS VALID FOR 60 DAVS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SFWFR <br />DRAINAGE <br />WATER <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC --- <br />PLANNING <br />STREE, <br />O <br />A PIOVZD FOR (aT TAU I N DATE <br />1I;Z�ASC N NU co_—_�I— DATE <br />DRIVEWAY SECTION <br />fI LIP <br />30-P Lao.I <br />The undersigned owner hereby agrees to hole and save harmless <br />the City of Everett from any and all claims for damages. costs. <br />Papenms, or causes of action that may arise because of Installation <br />end maintenance of the Improvement or other rlghbof-way use <br />hereto applied for and further agrees to ramove same upon notice <br />from The City and to replace public property damaged Thereby. <br />SitiqATURE GP APPLICANT <br />ADDRESS <br />vFacF_ rr c✓n 3eaoy <br />CITY ZIP <br />TELEP40NE NUMBER ALTERNATE <br />x- <br />CONSTRUCTION/AS BUILT FEE <br />- r ', I ..; I .r .. , r.- , <br />1978 <br />