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II APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />LeiType or print clearly with Ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS nj <br />EVERETT. WASHINGTON PERMIT NO. <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY <br />HEREBY APPLIES FOR PERMISSION TO <br />AT THE FOLLOWING LOCATION <br />DRAWING (WORK TO BE DONE) OR THREE PLANS CACHED: <br />I <br />\(O ..Ubltlt wor\c i% <br />w.... a r <br />` o�e`r�rnw�-i. I a.•�( <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 />WATER <br />STREET <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />A PPRUVtU VVR CONSTRUCTION 'DATE <br />\0 <br />C cz.-' <br />DRIVEWAY SECTION <br />LIP <br />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 />expenses, or causes of action that may anse 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 />f <br />SIGNATURE OF APPLICANT/_ — <br />ADDRESS <br />i <br />a s 9 ER <br />-.3s s Yo <br />TELEPHONE NUMBER Al ERNATE <br />APPROVED AS CONSTRUCTED DATE <br />1 <br />S <br />ON <br />