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everett <br />APPLICATION FOR RIGHT-OF—WAY USE PERMIT <br />. Type or print clearly w}(h Ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS i <br />EVERETT. WASHINGTON PERMIT NO. <br />� / 1 <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF <br />HEREBY APPLIES FOR PERMISSION <br />AT THE FOLLOWING LOCATION <br />DRAWING (WORT( TO BE DONE) OR THREE PLANS ATTACHED: <br />/y6 all al- el, /7 <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 CONSTRUCT!ON <br />SEWER <br />DRAINAGE <br />WATER <br />STREET <br />DEPARTMENT APPROVALS <br />C014b1UNICATIONS <br />TRAFFIC <br />PLANNING <br />APPROVED FOR CONS5� CTION DATE <br />5 r t. <br />DRIVEWAY SECTION <br />E� I" LIP <br />(� 30' 1. f <br />�i <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 or other right-of-way use <br />hereto applied for and further agrees to remove same upon notice <br />from the City and to replace public property damaged thereby. <br />� <br />_ <br />SIGNAT EOFAPPLICANT <br />E <br />�`I <br />ADDRE <br />iU V�,: S ,�a <br />CIIY <br />ZIP <br />,C i <br />.,pit acc <br />�7us <br />1 <br />