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everlelt <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. <br />APPLICAAT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY: <br />HEREBY APPLIES FOR PERMISSION <br />AT THE R LLOWING LOCATION 6 3 Q 7 Fi i- w 0 a o/ <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />n� CC371i1�c-f•��j <br />PERMP'r I5 %ItoLIU FOR 60 041VS <br />COPY OF THIS APPE.ICATION TO BE POSTED <br />ON JOBSITE. <br />C.fa(I_° FOP. IVIISPECTION 259-881 11 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />DRAINAGE <br />STREET <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />PLANNING <br />APPROVED FOR CONSTRUCTION DATE <br />APPROVED AS CONSTRUCTED DATE <br />S9�/d�s0 <br />DRIVEWAY SECTION <br />• • 1 <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 />expanses. or causes of action that may arise because of instaaation <br />and maintenance of the improvement or other right -a: -way use <br />hereto applied for and further agrees to reprove same upon aohce <br />am the City and 10 ren' public properly damaged thereby <br />i <br />TELEPHONEI ALTERNATE <br />DATE <br />' E E 1978 <br />CUSTCMER <br />