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everetl <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print dearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT. WASHINGTOh PERMIT NO. <br />/ J how <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY: <br />HEREBY APPLIES FOR PERMISSION TO_.G-tG--A <br />i <br />AT THE FOLLOWING LOCATION <br />DRAWING (WORK TO BE 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 INSP ZCTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />SEWER <br />;1 <br />DRAINAGE <br />STREET <br />COMMUNICATIONS <br />PLANNING <br />�N✓` A I <br />AP ROVED R NS UCTTON DATE <br />-14PPROVrITAS CONSiRUC ED DATE <br />CONSTRUCTION/AS BUILT <br />DRIVEWAY SECTION <br />I" LIP <br />'I 30" <br />The undersigned owner hereby agrees 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 arose because of installatmn <br />and mmntennnce of the Improvement or other right-ol-wny 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 />VIA <br />To <br />r <br />CIT <br />—� - Ll <�- z10 <br />TELE NU En ALTERNATE <br />DATE i <br />