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OF ir ,4 aw <br /> cvclrN <br /> APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> Type or print clearly with Ink <br /> PRESS HARD - YOU ARE MAKING COPIES <br /> PUBLIC WORF E <br /> EVERETT,WASHINGTON PERMIT NO. rI <br /> APPLICANT (UNDERSIGNED)AND FIRM REPPESENTED,`IF ANY. _- <br /> HEREBY APPLIES FOR PERMISSION TOf <br /> AT THE FOLLOWING LOCATION— .PIP 5a Le I <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br /> is <br /> I <br /> DRIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 DAYS <br /> COPY OF THIS AI3PLICATION TO BE POSTED I" LIP <br /> ON JOBSITE. <br /> CALL FOR INSPECTION 259-961 7 r <br /> 24 HOURS BEFORE CONSTRUCTION Th,) undersigned owner hereby agrees to hold and save harmless <br /> the Clty of Everett from any and all claims for damages. costs. <br /> es pensee,or causes of action that may arise because of Inste.labon <br /> and maintenance of the improvement or oliler right of-Way Ilse <br /> hereto applied for and further agrees to remove same upon notice <br /> from the City and Ic replace public properly damaged thereby. <br /> DEPARTMENT APPROVALS <br /> SEWEn COMMUNICATIONS <br /> paaNnaE TRAFFIC <br /> WATER ,' n N (7I FMN a ,/ S10NAT R�APPLICANT <br /> STREET sf' TI' •Cl�lif ApeRE55 ^I'Gy <br /> 09P.1 C <br /> IT, 7�y/fio ITV — ZIP <br /> AVPHUVt `U- 1 N _ <br /> ATE <br /> TT3fi3V3 30 YTIO TELEPHONE NUMBER ALTERNATE <br /> -1 1 <br /> ,u"rfWVCI'; .'4.I in�( hLC' Anil - _ - --- -- <br />