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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with ink <br />rOU ARE MAKING COPIES <br />PUBLIC WORKS c:7 <br />EVERETT, WASHINGTON PERMIT <br />r <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISSION TO_. <br />AT THE FOLLOWING <br />DRAWING (WORK TO <br />°27.PD- F <br />DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FOR CD DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR 1EIS rPECTIOM 2:50-831 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />SEWER <br />DDAINAOE — -- <br />STREET <br />COIAMUN CATIONS <br />TRAFFIC <br />PLANNING <br />APPROVED FOa CONSTRUCTION /0/OAT. <br />APPROVED AS CONSTR TED "� DAIE <br />�\ v <br />J.Q. <br />a <br />DRIVEWAY SECTION <br />—_—�I 30" <br />The undersigned owner hereby agrees to hold and save Rmmless <br />the City of Everett from any and all claims for damages, costs, <br />expenses. or causes of action that may .arise because at installAUOn <br />and maintenance of the improvement or Other nghl'eb'.vay use <br />herelo applied for and further agrees 10 remove same Upon notice <br />From the City and 10 replace public property damaged thereby <br />Lu <br />:vIGNATURE OF APPLICANT /- <br />out `_e, IlA'f-, <br />ADCnF$57 <br />CITv ZIP <br />1LI U'IIONE NUMBER ALTERNATE —_— <br />DATE <br />FEE 1978 <br />