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evrre"rl <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 '(J <br />IT NO. <br />EVERETT, WASHINGTON '%� PERM <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY: =.} S r -=2fJy ti C <br />HEREBY APPLIES FOR PERMISSION TO GC.'.t>5T"� ZS f'= -r ILA—) <br />AT THE FOLLOWING LOCATION <br />DRAWING (WORK TO <br />/ 0) . <br />DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON .JOBSITE. <br />CALL FOR INSPECTION) 259-881 1 <br />24 HOURS BEFORE. CONSTRUCTION <br />DEPARTMENT APPROVALS <br />SETS [1u COMMUNICATIONS <br />+ <br />DRAINAGE TRAFFIC <br />WATER <br />STREET <br />PLANNING <br />3-4:G <br />DATE <br />�1 a(181 <br />DRIVEWAY SECTION <br />I" LIP � <br />I 30 I <br />I JO� <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, orrb'auaes of actlo th1t mey arise because of installation. <br />and maintenance of the Improvement or other ngh4of-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 />SIGNATURE OEAP ANT <br />17�i <br />ADDRESS <br />33 <br />CITY <br />TELEPHONE NUMBER ALTERNAIE <br />