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Type or print .Iearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT, WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: / <br />PERMIT NO. <br />HEREBY APPLIES FOR PERMISSION TO <br />AT THE FOLLOWING LOCATION <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED:` <br />it �V1ecL � <br />- <br />�� <br />�O-� �� � erg �(�� �� �g m ✓`-- <br />Uj L�• <br />ar <br />� y <br />PERMIT IS VALID FOR SO DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-13B 1 I <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />DRAINAGE <br />STREET <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />APPROVED FOR CONSTRUCTION DATE <br />AP RCVED AS CEINSTRUCTED DATE <br />DRIVEWAY SECTION <br />L�jl'r LIP <br />30" f 01 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 />ea penses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other Nghl-ol-way use <br />hereto applied for and lurther agrees to remove same upon notice <br />from the City and to replace public property gamegpd. trimeby. <br />TELEPHO NUMBER ALTERNAIE <br />DATE <br />INITIAL 04 PECTION REQUESTED FEE 1978 <br />