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AFFLiGATI-ON 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. —&Lb - <br />APPLICANT (U-JDERSIGNED) AND FIRM REPRESENTED, IF ANY. � 7 �c /6 —,PIb►a L — j <br />HEREBY APPLIES FOR OERMISSION TO <br />AT THE FOLLOWING LOCA71ON <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FOR 60 DAVS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />DRAINAGE TRAFFIC <br />WATER <br />STREET <br />PLANNING <br />APPROVED FOR CONSTRUCTION DATE <br />APPROVED AS CONSTRUCTED DATE <br />DRIVEWAY SECTION <br />fl" LIP <br />30'_ 30" <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 />expenses. or causes Of action that may arise because of Installalion <br />anC 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 10 replace public property damaged thereby <br />557?-;,-, 334 <br />TELEPHON NUMBER r ALTERNATE <br />DATE <br />-�-�� <br />FEE 197E <br />CUSTOMER <br />