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r1: <br />everetl <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 <br />EVERETT, WASHINGTON PERMIT NO. MIMI <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISSION <br />AT THE FOLLOWING LOCATION 43 Gr% ritc/C Oenit"' P/, <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />J,��SJ�����f�/ <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-681 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPontrnl c <br />SEWER ---�., <br />L <br />DRAINAGE <br />WATER <br />STREET <br />APPROVED FOR CONS RU r ION V DATE <br />APPROVED AS CONSTRUCTED DATE <br />DRIVEWAY SECTION <br />+I" LIP <br />I� 30 "T • �3� •1 <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett Iron. 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 />TELEPHONE IN BE ALTERNATE <br />DATE <br />REFERENCECOPY FEE 1978 <br />