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ereretl <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with Ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS /] <br />EVERETT, WASHINGTON PERMIT NO. <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY: -- <br />HEREBY APPLIES FOR PERMISSION <br />AT THE FOLLOWING LOCATIONS 30 7 <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <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 CONSTRUCTION <br />SEWER <br />DRAINAGE <br />WATER <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC �— <br />PLANNING <br />DRIVEWAY SECTION <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 />f Cpenses. at Causes of ACllon That may arise because of installation <br />ano maintenance of the Improvement or other nghbof-Way see <br />nerelo applied for and further agrees to remove same upon notice <br />from the City and to replace public ploperty damaged thereby <br />L I L� --- <br />BG fU APPLICANT ) A' <br />STREET ADORLs <br />VTv - <br />7�TPsfFu i DATE <br />n <br />APPROVED AS CONSTRUCTED DATE <br />REFERENCECOPY fEE <br />B - 7 33/ <br />ONE NUMBER tl <br />l U <br />