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POP <br /> °, 1 <br /> rverr!1 � <br /> Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> �j Tyne or print clearly with Ink <br /> PRESS HARD - YOU ARE MAKING COPIES <br /> PUBL17 WORKS <br /> EVERETT, WASHINGTON PERMIT NO. <br /> APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY. ------ --- <br /> HEREBY APPLIES FOR PERMISSION TO <br /> AT THE FOLLOWING LOCATION <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br /> DRIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 DAYS a — .+ <br /> COPY OF THIS APPLICATION TO BE POSTED <br /> ON JOBSITE. <br /> CALL F .,R INSPECTION 259-881 1 C' <br /> 24 HOURS BEFORE CONSTRUCTION The undersigned owner hereby agrees tp hold and save harmless <br /> the City of Everett from any ane all claims for damages, costs, <br /> expenses.or causes of action that may arse because of Installation <br /> and rrlalntPnance of the Improvement or other right-of-way use <br /> Panic,applied for and further agrees to remove same upon notice <br /> from the City and to replace public properly damaged thereby. <br /> DEPARTMENT APPROVALS <br /> SEWER COMMUNICATIONS <br /> 6RA1NABE TRAFFIC <br /> WATER ) i I ll R'I N SIONA.YRE OF APPLICANT . <br /> I f II v y� <br /> STREET ADDRESS <br /> �gT e Ur 7�Y�FO nr _ tlP <br /> AP V UCTIO �A7E <br /> TT3F13V3 �0 yT13 TELEPHONE NUMBER ALTERNATE <br /> .1gs0 a lToy! �j duY <br /> AP V IAS CONSTRUCTED DATE DAT <br /> HEFERENCECOPY FEE 1978 <br />