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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly Wdh DTA <br />ki <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS EVERETT, WASHINGTON PERMITN1O.Z9 / <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: S G. `L ( �. STX L.-S7OZ <br /><, n <br />Al THE FOI LOWING LOCATION % I�71�- S•i Er <br />DRAWING (WORK T. 0 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 259-1361 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />DRAINAGE <br />WATER <br />STREET <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TNAFFIC <br />WVA v 7a� <br />PLANNING <br />APPROVIE0 FOR , O I N DATE <br />I ... <br />APPROVED AS CONSTRUCTED - DATE <br />CUSTOMER <br />DRIVEWAY SECTION <br />I" LIP <br />30' 30' <br />The undersigned owner hereby agrees to hold and save Larrnim <br />the City of Everett from any and all claims for dameDes. costs, <br />Bs Penns. Of causes of action that may arise because of Installation <br />.it maintenance of the Improwmenl or other right-ol-way use <br />hereto applied for and further agrees to remove same upon notice <br />Nam the City and to replace public property damaged thereby <br />frDNA1URE Of APPEICAN <br />ADDRESS <br />L kg') - 9 Pal <br />CITY ZIP <br />1 EPNDNF NUMBER ALTERNATE <br />DATE <br />