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COCrC1I <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />0V Type or print clearly with ink <br />PUBL!C WORKS PRESS HARD - YOU ARE MAKING COPIES <br />EVERETT. WASHINGTON <br />APPLICANT (UNDERSIGNED( AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISSION TO /-% b_ 4/7 , <br />PERMIT NO. - It , <br />AT THE FOLLOWING LOCATION <br />View ,c my <br />DRAWING (WORK 70 BE DONE) OR THREE PLANS ATTACHED: <br />4"r r <br />PERMIT IS VALID rOR 60 DAYS <br />DRIVEWAY SECTION <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. ' ;�11" LIP <br />CALL FOR INSPECTION 2s9-8.9 1 t�-+4 --- 30" <br />24 HOURS BEFORE CONSTRUCTION <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. Or causes of action that may arise because of installation <br />and maintenance of the Improvement or other ught-of-way use <br />hereto applied for and further agrees to remove sane upon notice <br />from the City and to replace public property damaged thereby, <br />DEPARTMENT APPROVALS <br />SEWER --- <br />DRAINAGE <br />WATER <br />COMMUNICATIONS <br />TRAFFIC <br />r'LANNING — <br />STREE <br />A ROVED FO CO Tq ION 4aTE / <br />� <br />''� `fir <br />PPR VED CONS RU D <br />DATE <br />$1 NA. 1E ICAN1 <br />zu, <br />rEi�sF�� a�7 YSos <br />"AL 1!n- ( <br />