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everfell <br />APPLICATION FOR RIGHT-OF-WAY USE PERMITi:' 1 ✓^ //11 <br />Type or print clearly with Ink G`C�Y� <br />PRESS HARD - YOU ARE MAKING COPIES ,j/{�lll , 1 <br />PUBLIC WORKS <br />EVERETT, WASHINGTON PERMIT NO. <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISSION TO G O��✓-!.1 ' I� ��''� h(A-A f- -T <br />AT I HE 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 INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />SEWER Q�iLRAMONS <br />7T-"A?VI;0 YI l;) _ <br />DRAINAGE jqlUffF.tQ , „ I <br />WATER PLANNING <br />STREET <br />,,.�-� . ` �'j get 0 ^U It <br />,�„z V V <br />DATE <br />CONSTRUCTION/AS BUILT <br />DRIVEWAY SECTION <br />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 />eApenses. or causes ul action that may arise because of installation <br />and maintenance of the improvement or other right-ol-way use <br />hereto applied for and further agrees to remove same upon nonce <br />from the City and to replace public property damaged thereby. <br />r _ <br />$IGt ATURE OF APPLICANT <br />ADDRESSy�—��/ <br />CITY Z1��� JwO <br />TELEPHONE NU'aPER ALTERNATE <br />,-7-7 <br />DATE <br />