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a, <br />everetl <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT, WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY. <br />HEREBY APPLIES FOR PERMISSION TO I <br />i <br />AT THE FOLLOWING LOCATION_ <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />N C,TT'' <br />1-� g f r Butts <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 t <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />SEWER COMMUNICATIONS <br />DRAINAGE <br />WATER PLANNING <br />STREET <br />L r v <br />AP D FOR GONS VCT ION DATE <br />PERMIT NO. 7 i If' <br />Ir �.� put-, <br />�.vC.Tc <br />DRIVEWAY SECTION <br />I ( I" LIP <br />r 30' ,j _I_30" <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damagescosts, <br />a,penses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other nghl-of-Way use <br />hereto applied for and further agrees tp remove same upon notice <br />from the City and to replace public property damaged thereby. <br />' rf <br />SIGNATURE OF AR ICANT <br />ADDRESS <br />APPROVED AS CONSTRUCTED DATE <br />TELEPHONE NUMBER --ALTERNATE <br />p ATT <br />u <br />