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evered <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 PERMIT NO.� <br />EVERETT. WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF <br />HEREBY APPLIES FOR PERMISSION <br />AT THE FOLLOWING LOCATION <br />gs-ZG FP�er4� 4�E' <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />('l—,-i GSG.. St'S /Pns !.• L lryU.r. `'l <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTI <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 />APPR V D -PR CONSTRUCTION DAT <br />VEO AS CONSTRUCTED DATE <br />S.c,.; �i. wo lC.� ✓� <br />DRIVEWAY SECTION <br />+I" LIP <br />L, <br />Ir30'Wi I <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 />e,penses. or causes of action that may arise because of installation <br />ano 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 />Lri tic <br />-Sd <br />$IGNATORE OF AP0.L10l� 1" L C JE1 <br />ADDRESS 1nr' <br />F-- �3T' 138Qi8Z0'S <br />City L I r- ZIP <br />353 28g8 -. 11 <br />TELEPHONE NUIdOER � , ,ALTERNATE <br />