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etre►dr <br />APPLICATION FOR RIGHT-OFfWAY USE PERMIT <br />Type or print d"rly with 11111 <br />PRESS HARD - YOU ARE MAKINb COPIES s, <br />PUBLIC WORK: - PERMIT NO..L12-�-- <br />EVERETT, WASHINOTON <br />APPLICANT (UNDERSIGNED) AND F-AM REPRESENTED, IF <br />HEREBY APPLIES FOR PERMISSION TO — <br />AT THE FOLLOWING LOCATION <br />DRPWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FOR 60 DAYS <br />CJPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-861 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DRAINAGE <br />STREET <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />DRIVEWAY SECTION <br />I \ j 1" LIP <br />0.1 <br />�--- <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 />expenses. or causes of action that may arise beCaUSE of installation <br />and maintenance of the Improvement at other right-of-way use <br />hereto applied for and further agrees 10 remove same upon notice <br />from the City and to replace public property damaged thereby. <br />TELEPHONE NUMBER ALTERNATE <br />/)o <br />CONSTRUCTION/AS BUILT <br />DATE <br />FEE 1978 <br />N : aIm�N7'u ?fib ? <br />