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W <br />APPLICATION FOR RIGHT-OF-WAY USE PERIIT <br />Type or print clearly with ink <br />PUBLIC WORKS PRESS HARD - YOU ARE MAKING COPIES <br />EVERETT, WASHINGTON 7 <br />�yTM� / PERMIT N0. <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: �%ltr�./'�':N'�V <br />HEREBY APPLIES FOR PERMISSION TO_,//-��x�7Z5�1v- �Z— <br />AT THE FOLLOWING LOCATION <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERIMIT IS VALID FOR GO DAYS <br />COPY GF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR IMSPECT10--4 259-8" 31 9 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />ORAINAGC <br />WATER <br />STREET <br />DEPARTMENT APPROVALS <br />COM MUNI C A'IONS <br />TRAFFIC <br />PL ANNWG <br />APPROVED FOR CONSTRUCTION DALE <br />APPROVED AS CONSTRUCTED DATE <br />DRIVEWAY SECTION <br />�i� <br />�= ;30„ <br />I <br />The undersigned owner hereby agrccs to hold and Savo 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 Omer Nght.ol.way ase <br />hereto applied for and further agrees 10 remove Same upon notice <br />from the City and 10 replace public property damaged thereby <br />Z=4ATURE OF APPLICANIF <br />:5y// if'e rnz u T Ct <br />ADDRESS —. <br />CITY ZIP <br />�sSu.uEn <br />TELEPNONE NUMDER ALTERNATE <br />7 <br />DAY /���-- <br />