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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with ink <br />PRESS HARD - YOB ARE MAKING COPIES <br />PUBLIC WORKS <br />PERMIT NO. <br />EVERETT, WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REP1��,^� <br />RESENNT\1ED. IF ANY. <br />HEREBY APPLIES FOR PERMISSION TO URE�c\�� --- <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 259-8931 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />DRAINAGE <br />WATER <br />STREET <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />APP OVED I'YM WNW TROC110N 0 E <br />1.8 s fi 80 <br />APp S ON4TCTED 0 TC <br />DRIVEWAY SE:.IION <br />I" LIP <br />j"30-1 _ 1 30" <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 tight -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 />SIGN TUBE O I•PPLIGANI A <br />U4AE c ear hIVQ��I��L <br />AGOPE55 <br />CITY ZIP <br />TELEPRONE 111MpER ALTERNATE <br />❑AlE <br />CONSTRUCTION/AS BUILT <br />FEE <br />