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> ,>r <br />everett <br />Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />VType or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS 0 7 <br />EVERETT. WASHINGTON PERMIT NO. _ �l <br />APPLICANT (UNDERSIGNEDI 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 />PERMIT IS VALID FOR GO 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 />SEWER <br />DRAINAGE <br />WATER <br />STREET, <br />DEPARTMENT APPROVALS <br />e <br />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />DATE <br />eON <br />DDAIS <br />RUCrION;AS BUILT <br />DRIVEWAY SECTION <br />I <br />I" LIP <br />The undersigned owner hereby agrees to hold and save harmless <br />'ne City of Everett from any and all claims for damages. costs, <br />••,pensns. or causes of Fiction that may anse because of Installation <br />and mmnlenance of the Improvement or other light -of -Way loge <br />hereto spphed for and further agrees to remove some upon notice <br />from the City and to replace public property damaged thereby <br />SIGNATURE OF AMICANI <br />J,J -j..jfa AniaJa.4 `Ala. y� <br />ADDRESS <br />14e(/ w A 99011 <br />CI v zip <br />HBe — -7 <br />TELEI•EIONE NUMBER ALTERNATE <br />1978 <br />