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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.201 <br />EVERETT. NASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY:_ ! r t Mo�-�,J' <br />HEREBY APPLIES FOR PERMISSION TO <br />AT THE FOLLOWING LOCATION a 6 d 7 ttL /Lp /il <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 />DEPARTMENT APPROVALS <br />SEWER <br />DRAINAGE <br />WATER <br />STREET t-1•J <br />COMMUNICATIONS <br />TRAFFIC <br />1 _ 4ANNING, <br />.. i <br />1 <br />APPROVED FOR ONSTRUCTION DA <br />DRIVEWAY SECTION <br />I \ +I' LIP <br />�30„ <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 />¢-parses. or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use <br />hereto applied for and IUdher agrees to remove same upon OOIICC <br />from the City and to replace public property damaged thereby. <br />SIGNATURE OF APPLICANT <br />ADDRESS <br />CITY <br />ZIP <br />36'7 <br />IELEPHON: NUMBER <br />ALTERNATE <br />7- <br />DAIE <br />— �! <br />0 <br />