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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with Ink <br />ilk <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS ✓ <br />PERMIT NO. <br />EVERETT. WASHINGTON , <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />In In,-,v r �_C I,\ 'Y"r� vin ��i !- fl 5 •l• C <br />HEREBY APPLIES FOR PERMISSION TO <br />AT THE FOLLOWING LOCATION v <br />DRAWING (WORK TO RE DONE) OR THREE PLANS ATTACHED: <br />* S fifit11 i fi e Y 51WC'e U.ti DEP' F3GOC-r T- 95 4W<2 TILT /e6,4j <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 />DRAINAGE <br />WATER <br />DEPARTMENT APPROVALS <br />I <br />COMMUNICATIONS <br />'TRAFFIC — <br />PLANNING <br />APPROVED FOR CONSTRUCTION DATE <br />APPROVED AS CONSTRUCTED DATE <br />DRIVEWAY SECTION <br />The undersigned owner hereby agree- to hold and save harmless <br />the City of Everett from any and all claims for damages, costs, <br />e.penses. or causes of action trial may arise because of installation <br />and maintenance of the Improvement or other right-ol-way use <br />hereto applied for and further agrees to remove same upon nonce <br />from the City and to replace public property damaged meleby. <br />SIGNAT OF APP0 <br />�s!N /v / 7 f" <br />_�O <br />AGDR.-SS <br />9r cG <br />GITV <br />ZIP <br />I:5-/ef,/ 2 : <br />yp- ' <br />N <br />TELEPHONF MEIER <br />ALTERNATE <br />/r z c <br />GATE <br />INITIAL INSPECTION REQUESTED <br />