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Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />�j Type or print Off with ins <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC Wf7RKs <br />EVERETT. WASHINGTON PERMIT NO.__� <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY:_ t.:�___j�L� �V \•.� <br />HEREBY APPLIES FOR PERMISSION <br />� n <br />AT THE FOLLOWING LOCATION_ �`11 f �,L•: _L•1T\ - LI;. \\SL/ i VI \• <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 />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />' A"'-?-- 7�3U�iPC� <br />APPROVCD RCONSIHMIION O�TE <br />i <br />APPROVED AS CONSTRICTED DATE <br />INITIAL INSPECTION f:FQUESTLD <br />DRIVEWAY SECTION <br />, LIP <br />30" <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everell from any and all claims for damages, costs, <br />expenses, of cair es of action that may arise because of installation <br />and maintenance of the improvement of other nghLol-way use <br />hereto applied for and further agrees to remove same upon notice <br />from the City and to replace public properly damaged thereby. <br />SIGN -UR t01APPL ^AN• L j �i <br />ADDRESS <br />I <br />CITv zip <br />TEE[ ND�N E�UAmER nIiERNnTE ' <br />ITE <br />1978 <br />