Laserfiche WebLink
everett <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with Ink <br />PRESS HARD - YOU ARE MAKING COPIF5 <br />PUBLIC WORKS <br />EVERETT, WASHINGTON PERMIT �No APPLICANT (UNLFRSIGNED) AND FIRM REPRESENTED, IF ANY:.�e'Lr'1.1/SQjt, �(O/[/ <br />HEREBY APPLIES FOR PERMISSION TO <br />T/�) C Q/4,IS /iI"fW dtZG,EJ r I� <br />1` utT l�l�/i�4 <br />AT THE FOLLOWING LOCATION / I I r 79TN St S, < <br />DRAWING , WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FOR SO DAYS <br />COPY OF THIS APPI-ICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DRAINAGE <br />STREET <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAf TIC <br />W�XI I&W <br />PLANNING <br />I <br />APPROVED FOR CONSTRUCTION DATE <br />'� V(5 EIS CONSTRUCTED neN <br />DRAr-WAY SECTIJN <br />I" LIP <br />30'��� <br />The undersigned owner hereby agrees to hold and se" harmless <br />the City of E"rett from any and all claims for damages, costs, <br />Pspenses. or causes of Action that may allae bKouse of Installallon <br />and mamtenance of the Improvement or other rightol-way use <br />helel0 applied fur and further agrees t0 remove same upon noliLe <br />from the City and to replace public property damaged Ihmeby <br />SIGNATURE Of APPLICAN <br />3 ���2 Cam rs Y <br />ADO'If SS <br />CITY ZIP <br />T EPHOBEAIi AIIERNAIE <br />frog — <br />