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gve►eM <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 NO. <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: ' n c r <br />HEREBY APPLIES FOR PERMISSION TO <br />AT THE FOLLOWING LOCATION y/I L- /kZ J '/ /y -! 1 <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />No Puy+-�� ✓�o�z�c� P2m�- <br />Woe. C_omPl-'i <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALLFOR INSPECTION 259-681 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DRAINAGE <br />STREET <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />DRIVEWAY SECTION <br />I" LIP ll <br />-30'�1 O 30" 1 <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-of-way use <br />hereto applied for and further agrees to remove sari upon notice <br />Irom the City and to replace public property damaged thereby, <br />� r <br />PLANNING SIGNATURE OF APPLICANT <br />A71Wcu rum uurib1'RUCTION DATE <br />APPROVED AS CONSTRUCTED - , <br />TELEPHONE NUMBER ALTERNATE <br />