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#Amok_'.:71r1�•.�extyzrp--.Tw BCt9Y•- <br />tevlerell <br />APPLICATION FOR RIGHT-OF-WAY USE PERMI"1- / / //�► <br />e TYpe or print clearly with Ink <br />PRESS PARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT. WASHINGTON PERMIT NO. <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISSION TO G ©A-2 (+A- - -T <br />AT THE FOLLOWING LOCATION !75FQ Ir <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 />SEWER <br />DRAINAGE <br />DEPARTMENT APPROVALS <br />Q 1 01 <br />A IONS <br />TT'go`la ,0 Y I I 1 <br />1q�vwF19:... I <br />PLANNING <br />STREET GIGt O OIJA <br />RO�-- , �? � 5 <br />PVED FUCTION % Ci <br />DATE �j <br />h.-- —JET fu'jir ! -f. <br />♦u f ❑ A. G NSTRIICTF❑ DAII <br />DRIVEWAY SECTION <br />I'r LIP / I <br />J <br />30" <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 Net may arise because of installation <br />and maintenance of the improvement or other right-ol-way use <br />hereto apnhed for and further agrees to remove Same upon notice <br />from the City and to replace public property damaged thereby. <br />SIG ATURE OP APPLICANT ((// ��// <br />AOORESS <br />CITY ZIP <br />TELEPHONE NUMBER 7 ALTERNATE <br />