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evcrrtl <br /> APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> Type of print Cleariv With Ink <br /> PRESS HARD - YOU ARE MAKING COPIES <br /> PUBLIC WORKS <br /> EVERETT, WASHINGTON / PERMIT NO, 2 V1lL <br /> APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY. /// 6) c ) L <br /> HEREBY APPLIES FOR PERMISSION TO Stk1JCA.A <br /> AT THE FOLLOWING LOCATION _ w S w � - Q Gja-4 , . <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br /> i <br /> I <br /> I <br /> I <br /> DRIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 DAYS <br /> COPY OF THIS APPLICATION TO BE POSTED ` I„ LIP -� <br /> ON JOBSITE. <br /> CALL FOR INSPECTION 259-881 1 304___ <br /> 24 HOURS BEFORE CONSTRUCTION The UndeUlgned owner hereby agrees to hold and save harmless <br /> the City of Everett from any and all claims for damages. costs. <br /> e.penes.or causes of action that may arise because of installation <br /> and maintenance of the Improvement or other nghboh Way use <br /> F <br /> erelo applied for and further agrees to remove some upon notice <br /> from the City and to replace public property damaged thereby. <br /> DEPARTMENT APPROVALS <br /> SEWER COMMUNICATIONS <br /> DRAINAGE TRAFFIC y� <br /> � <br /> WATER PLANNING 'NATURE Or APPLICANT <br /> STREET •pDgEss <br /> A PR E FO J R OATE C/ tIP <br /> / TELEPH NUMBER ^ ALTERNATE <br /> AP VtO AS— NSTRUCTED DATE DATE <br /> CONSTRUCTION/AS BUILT FEE 1978 <br />