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CVffen APPLICATION FOR RIGI-I'r-OF-WAY USE PERMIT <br /> Type DI print clearly with Ink <br /> PRESS HARD - YOU ARE MAKING COPIES <br /> PUBLIC WORKS PERMIT NO. 11-- <br /> EVERETT.WASHINGTON <br /> APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY. — <br /> HEREBY APPLIES FOR PERMISSION TO <br /> AT THE FOLLmWING LOCATION_./OG 77 AZ' S,Id IeZ' pi���`� <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br /> I <br /> DRIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 DAYS <br /> COPY OF THIS APPLICATION TO BE POSTED �- I" LIP / I <br /> ON JOBSITE. X30' _ _ X30" <br /> CALL FOR INISPECTION 259-681 1 r "I <br /> 24 HOURS BEFORE CONSTRUCTION The undersigned owner hereby agrees to hold and care harmless <br /> the City of Everett from any and all claims for damages, costa. <br /> evpenses,or causes of sclion that may arise because of inalallahon <br /> Iend maintenar:o of the improvement or nlher agh4obv:ay use <br /> hereto applied for and further agrees to femuve tame upon notice <br /> from The City and to replace public property d6maged thereby. <br /> DEPARTMENT APPROVALS <br /> SEWER COMMUNICATIONS <br /> DRAINAGE fRAfrIC I+C""✓ ` /� <br /> (/ <br /> RE OF A <br /> PLANNING r'F`0 <br /> N� r <br /> W�TcR /// <br /> STREET <br /> p'V LIP - <br /> w <br /> AMOV5 C I Oa E TFtEvrON[NLIMe[n At t[nNneF <br />