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PUBLIC WORKS <br />EVEREIT, WASHINGTCN <br />) <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with ink <br />PRESS HARD - Y0U ARE MAKING COPIES 22 <br />PERMIT NO. 60 /d-5' <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, iF ANY: <br />HtAEBY APPLIES FOR PERMISSION <br />AT THE FOLLOWING LOCATION _(�'� '✓'� a� <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATT!.EX <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 />STaEFT <br />DEPARTMENT APPROVALS <br />51" L <br />DRIVEWAY SECTION <br />IFS-_ I <br />( I" LIP <br />.30yF. .�.30" <br />The undersigned owner hereby agrees to Fold and save harmless <br />the City of Evorelt 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 or other right-of-way use <br />hereto applied for and further agrees to remove same apon notice <br />from The City and to replace public properly damaged thereby, <br />APPLICANTn <br />$16.ATU ,E OF <br />ACCRESS <br />f & eIF? IA <br />CITY <br />r)S.) 3SS <br />ZIP <br />/703� <br />__ <br />TELEPHON NUI ER <br />ALTERNATE <br />CATS <br />CONSTRUCTION/AS BUILT TEE 1978 <br />