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ii <br />PUBLIC WORKS <br />EVERETT, WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with ink <br />PRESS HARC - YOU ARE MAKING COPIES <br />PERMIT NO. 7r <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY. <br />HEREBY APPLIES FOR PERMISSION TO— _.. <br />AT THE FOLLOWING LOCATION �`�—T ~ 5 �' J' wi -- <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 />STREET <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />APPROVEDEOR CONSTNUCTION DATE <br />APFPOVED ASCONSi RULED GATE <br />DRIVEWAY SECTION <br />LIP <br />30' �+ 30" <br />r 1 <br />The undersigned owner hereby agrees to hold and save harmlecs <br />The City of Everett from any and all claims for damages. costs. <br />espenses. or causes of action flint may arise because of installation <br />and maintenance of the improvement or other rlght-ol-way use <br />hereto applied for and further agrees To remove same upon notice <br />from the City and to replace public property damaged thereby <br />I EIFnHON�AIIMe[R l ALIERNAIf — <br />FEE �D%B <br />CUST0MM <br />