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t ) <br />• / I <br />w <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 a <br />EVERETT, WASHINGTON PERMIT NO. Z3C! <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY:_ <br />HEREBY APPLIES FOR PERMISSION <br />AT THE FOLLOWING LOCATION _ _ 3 # Z I r , - V <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 259-661 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DRAINAGE <br />WATEh <br />DEPARTMENT APPROVALS <br />// J <br />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />//- III S-7 <br />ON/AS BUILT <br />WCTM6)/?t IQVt <br />DRIVEWAY SECTION <br />LIP <br />h30'1 <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 />eX penses, or causes of action that may arise because of installation <br />and malnfenanttb of the improvement or other nghl-Or-way use <br />hereto applied foJ and further agrees to remove name Upon notice <br />from the City and to replace public property damaged thereby. <br />ZLIRE r A _ <br />gSOL 14- ArE sue- i�st <br />ADDRESS J <br />CITY ZIP <br />If <br />TELEPHONE NUMBER ALTERNATE <br />