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PUBLIC WORKS <br />EVERETT, WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with Ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PERMIT NO. %1 <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISSION <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 INSPECTION 259-081 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />DRAINAGE <br />WATER <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />rLANNING <br />STREET <br />APPROVEU FOR C t TRU ION OnTE <br />DRIVEWAY SECTION <br />iiI - <br />-i I' LIP <br />�30 30„ <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Evorett from any and all claims for damages, costs. <br />expenses. w 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 />Irom the City and to replace public properly damaged thereby. <br />I <br />TELEPHONE NUMBER ALTERNATE <br />/ 2 -/7 Z` <br />[)ATE <br />