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everett <br />® APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />!r/ Type or print clearly with Ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERET'l, WASHINGTON <br />PERMIT NO.T r <br />APPLICANT (UNDERSIGNED) AND FIRM Rc PRESENTED, IF ANY: Newland Construction <br />HEREBY APPLIES FOF' PERMISSION TO_ install a 15 r dri <br />AT THE FOLLOWING LOCATION 7502 Evergreen Way <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />cc� eIks -see rlc�" <br />VVV <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 />DEPARTMENT APPROVALS <br />SEWER <br />I <br />1' <br />DRAINAGE <br />WATER <br />COMMUNICATIONS <br />TnAFFIC . <br />PLANNING <br />., <br />STREET rj <br />i� <br />APPROVED R CO ST UCTI, D E <br />APPROVED AS CONSTRUCTED DATE <br />INITIAL INSPECTION REQUESTED <br />0�a Ll <br />a1S 7/ S <br />DRIVEWAY SECTION <br />+I" LIP I <br />30" r 30" <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 property damaged thereby. <br />SIGNATURE OF APPLICANT - <br />P.O. Box 958 <br />Everett, We. 98206 <br />259-3161 <br />TELEPHONE NUMBER ALTERNATE <br />