Laserfiche WebLink
W <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with Ir�k <br />PRESS HARD - YOU A - MAKING COPIES <br />PUBLIC WORKS }^ <br />EVERETT, WASHINGTON PERMIT NO. <br />/ l <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY: l�1 _ �u YL GC. 1- L� ( _ u C To s•r.. 44. L... * .A, t <br />HEREBY APPLIES FOR PERMISSI )N TO O L'A r C _ S•G< LL .S <br />AT THE FOLLOWING LOCATION •3 / U / V vvl 1 h (�"), C C, IFy '�• Q- / (NN <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 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />DRAINAGE <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />STREE <br />!I'PPROVED FORE NSTj1UCTION DATE <br />APPROVED AS CONSTRUCTED DATE <br />DRIVEWAY SECTION <br />r� I" LIP 71. <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-ol-way use <br />hereto applied fur and lurther agrees to remove same upon notice <br />from the City and to replace Public property damaged thereby. <br />SIGNAL OF APPLI <br />u /3 / 9 v -/ c r-1; 7r-- <br />ADDRESS <br />sezOG <br />CITZ ZIP <br />TELEPHONE NIMBER ALTERNATE <br />// 2 % <br />DATE <br />-- REFERENCECOPY <br />IW'il:1 <br />