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nd <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, IF ANY'. // /- C,5G 0 T-aq <br />HEREBY APPLIES FOR PERMISSION TO <br />--1 -I �A7IOlQ-� <br />AT THE FOLLOWING LOCATION -' �` ^<1 - <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />MIi <br />14( <br />PERMIT IS VALID FOR 80 DAVS <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 />PLANNING <br />/ I <br />P OVED FOR CGUITUTION <br />DATE <br />PPROVED AS CONSTRUCTED <br />DATE <br />CONSTRUCTION/AS BUILT <br />r <br />DRIVEWAY SECTION <br />+I' LIP <br />P0„ <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 msiallahon <br />end maintenance of the Improvement or other fight of -way use <br />hereto applied for and further agrees to remove Same upnn notice <br />from the City and to replace public property damaged thereby. <br />TEL� �M �� <br />�978 <br />ALTEHNAtC <br />DAT/ <br />rEET/�'I r 1 <br />