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!Y!f!M <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 <br />PERMIT NC. <br />EVERETT. WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISSION TO — <br />AT THE FOLLOWING LOCATION 1,310 G-/:; 4 jV T <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BF 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 />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />APPROVED F R CONSTRUCTION r I DATE <br />APPROVED AS CONSTRUCTED DATE <br />INITIAL INSPECTION REQUESTED <br />DRIVEWAY SECTION <br />`I" LIP <br />30 0 <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 installation <br />and maintenance of the improvement or other right-ol-way use <br />here�o applied for and further agrees to remove same upon notice <br />Irom the City and to t•=place public property damaged thereby. <br />/ I -j I 15' <br />TELEPHONE NUMBER ALTERNATE <br />