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ki APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with ok <br />PRESS HARD - YOU ARE Mt -KING COPIES <br />PUBLIC WORKS <br />EVERETT, WASHINGTON PERMIT NO.� /. <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISSION TO <br />AT THE FOLLOWING LOCATION / (19 % !/c !N c ! i— t_'J 5/`�- GO <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FOR 60 DAVS <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 />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />ATE <br />APPROVED F R CONSTRUCTION DATE <br />DRIVEWAY SECTION <br />LIP <br />30 fix �30 <br />The undersigned owner hereby agrees to hold and save harmless <br />the City or Everett from any and all claims for damages. costs, <br />expenses. or causes of uclion that may arise because of installation <br />and maintenance of the improvement or other tight -of -way use <br />here`o applied for and further agrees to remove same upon notice <br />Irdrnl the City and to replace public property damaged thereby, <br />3ti73-/5i5 <br />TELEPHONE NUMBER ALTERNATE <br />APPROVED AS CONSTRUCTED OATE <br />INSPECTION REQUESTED <br />