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everell ' <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: J� <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />r n <br />HEREBY APPLIES FOR PERMISSION <br />AT THE FOLLOWING LOCATION <br />DRAWING (WnRK TO BE DONE) OR THREE PLANS ATTACHED: <br />d P�a.� lGS <br />oil- DA <br />(� V <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 />SE4YIiR <br />DRAINAGE <br />WATER - <br />STREET <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />61�7— 7-D ATE <br />APPROVED WH CO— NSTiiUCTION / DAB-E <br />APPROVED AS CONSTRUCTED OA'E <br />DRIVEWAY SECTION <br />+11 LIP <br />r 30„ T 30" <br />The undersigned owner herebv 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 ]hat 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 note <br />tram the City and to replace public pronerly damaged thereby. <br />SIGNATURE OF APPLICANT / <br />TELEPHP'-' NUMBER ALTERNATE <br />DATE <br />INITIAL INSPECTION REQUESTED FEE 1878 <br />