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- I <br /> evcrcft 1 <br /> APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> Type or print clearly with Ink <br /> PRESS HARD - YOU ARE MAKING COPIES <br /> PUBLIC WJRKS C ^ C{ <br /> R M I T NO <br /> EVERETT.WASHINGTON PE . <br /> APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY.-- <br /> HEREBY <br /> NY: —HEREBY APPLIES FOR PERMISSION TO I ( '– -- <br /> AT THE FOLLOWING LOCATION p 55L bt <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: T <br /> CCaad 6 ci a�o�aC OX k'I J G( l <br /> I <br /> I <br /> I <br /> DRIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 DAYS ---� <br /> COPY OF THIS APPLICATION TO BE POSTED <br /> ON JOBSITE, 30" X30" <br /> CALL FOR INSPECTION 259-881 1 -"`7 <br /> 24 HOURS BEFORE CONSTRUCTION The undersigned owner hereby agrees to hold and esus harmless <br /> the C'ly of Everell from any and all claims for damages. costs. <br /> :.Ranges.or causes of action that may ansa because of Installation <br /> end maintenance of the Improvement or other right-of-way use <br /> hereto applied for and further agree,to remove same upon notice <br /> from the City and to replace public property damaged thereby. <br /> DEPARTMENT APPROVALS <br /> SEWER COMMUNICATIONS <br /> DRAINAGE TRAFFIC <br /> WATER -- PLANNING SIGNATURE OF APPLICANT <br /> SADDRESS <br /> STREET <br /> p lf &AA <br /> l.� ' 7/y�o ZIPAPPnt7VCQTq(-DNSTRULIICN <br />