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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 <br />EVERETT, WASHINGTON PERMIT NO. <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISSION <br />AT THE FOLLOWING LOCATION '—(� r I (�-) �- <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />1� 2 U1J ��n <br />CY <br />u� I <br />�r , S-�tdta <br />1 <br />= t• nnhA^',-l� CAR.s.J',Ai '1'��+ <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 />DRAINAGE <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />WATER PLANNING <br />STREET <br />fo I�EL 7 <br />AP D FOR CONSfT1UCT ION DAZE <br />APPROVED AS CONSTRUCTED DATE <br />INITIAL INSPECTION REQUESTED <br />DRIVEWAY SECTION <br />LIP <br />The undersigned owner hereby agrees to hold and save harmless <br />The City of Everett from any and all claims for damages, costs. <br />expenses. or causes of action that may arise because of installation <br />and maintenance of the Improvement or other right-of-way use <br />hereto applied for and further agrees to remove same upon notice <br />from the City and to replace public properly damaged thereby, <br />SIGNATLIRE Of APPLICANT <br />ADDRESS <br />I <br />TELEPHONE NUMBER 'AU ERNATE <br />DAT <br />1 <br />