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ir- <br />L <br />I; <br />everetl <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 <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES <br />,1 FOR PERMISSION TO `On A r • Pro <br />0S CA�YG\IP� <br />PERMIT NO. `�_ <br />AT THE FOLLOWING LOCATION 9'&02 - /,0 t'i five_ S,E E&row a, Ala. 99oos( <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />fe( P�av15 c-e vrnQpK> <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-681 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />DRAINAGE <br />WATI'R <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />4-11-g1 <br />DRIVEWAY SECTION <br />jI" LIP <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett (ram 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-of-way use <br />hereto applied for and further agrees to remove same upon notice <br />tram the City and 16 replace public property damaged thereby. <br />T <br />SIGNArMIL Or APPLICA <br />ADDR S <br />CITY ZIP IF <br />?Z TEALTERNATE <br />LEPHONE NUlARER <br />� �. — ov - <br />DATE <br />CONSTRUCTION/AS BUILT EE 1978 <br />