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ilk <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 PERMIT NO...=1—� <br />EVERETT, WASHINGTON t t / /. <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY: >-- <br />HEREBY APPLIES FOR PERMISSION TO <br />1� 77— — <br />AT 1 E FOLLOWING LOCATION <br />39V� Jr� r� L. Sril << / G✓� <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED•. <br />5i7� t 7-fIp Y SC /�c.�? U�1 DE2 F3GDC-r 7- �G I�UGL TILE 14M <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 />STREET <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />APPROVED FOR CONSTRUCTION DATE <br />APPROVED AS CONSTRUCTED DATE <br />INITIAL INSPECTION REQUF.STED <br />DRIVEWAY SECTION <br />I" LIP <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 />expen5e5. Or cruises of action that may arise because of Installation <br />and maintenance of the Improvement or other right-ol-way use <br />hereto applied lot and further agrees to remove same upon notice <br />from the City and to replace public property damaged thereby <br />AOFAPPL, <br />LNf <br />SIGN <br />ADDRESS <br />9Y�oG <br />CITY <br />IIP <br />TELEPHONE N MBER <br />A�TERNAI_ <br />//7 7/72 <br />- <br />DATE <br />