Laserfiche WebLink
0 <br />everen APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Typo or print clearly with Ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS PERMIT NO.QL— <br />EVERETT, WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, <br />HEREBY APPLIES FOR PERMISSION TO ---- <br />AT THE 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 INSPE[-TION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />S[WER <br />DRAINAGE <br />WATER <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />IS BUILT <br />DRIVEWAY SECTION <br />1'i LIP <br />L 30" L30" <br />The undersigned owner hereby agrees to hold and save harmless <br />the Clty of Everett from any and all claims for damages, costs, <br />cepanses. or causes of action that may aRSO because of installation <br />a,id maintenance Of the Improvement or other right-of-way Use <br />hereto applied to, and further agrees to remove same upon notice <br />from the City and to replace public property damaged thereby, <br />SIGNATURE OF APPLICANT <br />io o Bay 9S8 <br />ADDRESS <br />EV61.45 rr 28206 <br />CITY ZIP <br />ALTERNATE <br />TELEPHONE NUMDER <br />3 i9-8/ <br />DATE <br />