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PUBLIC WORKS <br />EVERETT, WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY: 14A 7- <br />HEREBY APPLIES FOR PERMISSION TO - ""� " � // <br />&O / /)i,// -5—> ECG Go-/ -O <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with mA <br />PRESS HARD - YOU ARE MAKING COPIES G <br />PERMIT NO. o c CL13o <br />=xiieFS"/ <br />✓ <br />AT THE FOLLOWING LOCATION <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: p-3"!X) <br />W kTts <br />PERMIT IS VALID FOR 60 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 />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />STREET <br />�- 3-CA <br />ou <br />TPPIAVEDFOR O STWuIION DATE <br />qpp AS G NSTIiUCTED DATE <br />CONSTRUCTION/AS BUILT <br />DRIVEWAY SECTION <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 right Df"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 />o? -7 -Y)s <br />HO TELEPNE MBER ALTERNATE <br />DATE 7 <br />