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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with Ink <br />ki <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS '7 <br />EVERETT, WASHINGTON ,�1`, j� �j '/PERMIT NO..l <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: 0' 7y (V L m airzt0A Y — <br />HEREBY APPLIES FOR PERM <br />AT THE FOLLOWING LOCATION L� �_����'�.>� '--%VC 4 <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: [ <br />° { W r) <br />E .-ts rt s - <br />--- c 01-61 AVID <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259—IBIS 1 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />DRAINAGE <br />WATER <br />STREET <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />APPROVED FOR CONSTRUGTIOIJ DATE <br />DRIVEWAY SECTION <br />I" LIP <br />L30" r �L30" <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damaged, costs. <br />expenses. or causes of action that may arise because of installation <br />and maintenance of the Improvement or other right-ol-way use <br />hereto applied for and further agrees to remove same upon notice <br />from the City and to replace public property damaged thereby <br />i <br />G TURE OF APPLI '� T �/L_ <br />AOD71E5S4/ <br />TIP <br />72S913T,�2— 35S-�4a8 <br />TELEPHONE NUMBER ALTERNATE <br />/ / -_ 2,In -X/ <br />APPROVED AS CONSTRUCTED DATE DRT <br />FEE 197E <br />