Laserfiche WebLink
f v� <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 />EVERETT, WASHINGTON / PERMIT NO. / <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, tF ANY:_j -P'y"Y'1Az----- - <br />HEREBY APPLIES FOR PERMISSION TC <br />AT THE FOLLOWING LOCATION / I (- " A✓g — <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />�jp WoY2v-s �t�t2M�l <br />ISStt�ID - �,J02'L �pmP�t,LI� <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 />WATER <br />STREET <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />Ap ED FOA CCNSTRUCTION DATE <br />APPROVED AS CONSTRUCTED DATE <br />INITIAL INSPECTION REQUESTED <br />DRIVEWAY SECTION <br />�— tI" LIP <br />30 � —� 30 <br />The undersigned owner hereby agrees to hold and sate 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 same upon notice <br />from the City and to replace public property damaged thereby. <br />SIGNAIURE OF APPLICANT <br />TELEPHONE NUMBER ALTERNATE <br />1978 <br />