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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> Type or p Int clearly with ink <br /> Ije <br /> PRESS HARD - YOU ARE MAKING COFIES <br /> PUBLIC WORKS <br /> EVERETT, WASHINGTON PERMIT NO <br /> APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY <br /> HEREBY APPLIES FOR PERMISSION TO— <br /> AT THE FOLLOWING LOCATION /Oz— -27 LcJa._ <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br /> I <br /> DRIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 GlaV:: <br /> COPY OF THIS APPLICATION TO BE POFTED �— 11" LIP <br /> ON JOBSITE. ' I <br /> CALL FOR INSPECTION 259-800 1 �30" } ��.30F.I <br /> 24 HOURS BEFORE CONSTRUCTION Tho undersigned owner hereby agrees to hold and uve harmless <br /> the City of Everett from any and all claims for damages. coats, <br /> expensesor causes of action that may arise because of Installation <br /> and maintenance of the Improvement or other DghDobway use <br /> hereto apphed for and further agrees to remove same upon notice <br /> from the City and to replace public property damaged thereby. <br /> DEPARTMENT APPROVALS <br /> SEWER COMMUNICATION" <br /> OP4114AGE TRAFFIC <br /> WATER PLANNING 117SIGNATURE OF APPLICANT <br /> --- X02yiq <br /> STREET ADDRESS <br /> �//Z-� <br /> / 2 7 /z/ cl ZIP <br /> "A P vet.. r PIr ION I DA f — <br />