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s <br />everetl <br />Q APPLICATION 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 <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY:_ <br />HEREBY APPLIES FOR PERM'SSION TO <br />AT THE FOLLOWING LOCATION C <br />DRAWING (WORK TO BE UONE) OR THREE PLANS ATTACHED: <br />IF-ef�cc�a� <br />w Ain <br />c, <br />� O S4- c t <br />�a0e <br />Q Q <br />PERMIT IS VALID FOR 60 DAVZ <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 />DRAINAGE <br />STREET <br />DEPARTMENT APPROVALS <br />COMMUNiCATnJNS <br />APPROVED FOR CONSTRUCTION DATE <br />APPROVED AS CONSTRUCTED DATE <br />DRIVEWAY SECTION <br />jl' LIP <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 />apenses. or causes of action that may arise because of installation <br />and maintenance of the Improvement or other right-of-way use <br />hereto applied for and further agrees to removP same upon notice <br />From the City and 10 replace public property damaged thereby, <br />\ SI AiURE OF AI L ANl <br />ADDRESS <br />C{ ZIP <br />� !�L5Z �5 _ <br />i ELE-I^ ONE NUM[ER � ALLERNAIE <br />DATV" ' - <br />INITIAL INSPECTION REQUESTED <br />1 <br />