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r.- <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 <br />EVERETT, WASHINGTON / PERMIT NO. FJQJ Z_ <br />5�1- <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY: <br />HEREBY APPLIES FOR PERMISSION TO <br />AT THE FOLLOWING LOCATION <br />q a6 d? <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 />WA I Ln - <br />i <br />STREET 1 —� <br />COMMUNICATIONS <br />TRAFFIC <br />PLANNING, <br />CONSTRUCTION/AS BUILT <br />DRIVEWAY SECTION <br />I" LIP _1� I <br />r 30'. 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 />expenses. or causes of action that may arise because of installation <br />and maintenance of the Improvevant or other right-of-way use <br />hereto applied for and further arees to remove same upon nouce <br />from the City and to replace aublic property damaged thereby. <br />SIGNATURE OF APPLICANT <br />ADDRESS <br />4Ucyte'y / d(/A- y.5 GO h <br />CITY ZIP <br />LSs- 3(L)67 _ <br />TELEPHONE NUMBER ALTERNATE <br />7 YC <br />DATE <br />978 <br />60 <br />