Laserfiche WebLink
s <br /> retl <br /> APPLICATION FOR HIGH -OF-WAY USE PERMIT <br /> Type or print clearly with Ink <br /> PRESS HARD - YOU ARE MAKING COPIES <br /> PUBLIC WORKS Q <br /> EVERETT, WASHINGTON PERMIT NO. <br /> APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF AN'I� � '— —=--- <br /> HEREBY APPLIES FOR PERMISSION TO <br /> AT THE FOLLOWING LOCATION��3 <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br /> I <br /> i <br /> I <br /> 00 its vii <br /> D:T <br /> DRIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 DAYS <br /> COPY OF THIS APPLICATION TO BE POSTED I" LIP <br /> ON JORSITE. 30" I <br /> CALL FOI` INSPECTION 259-881 1 I' 1 <br /> 24 HOURS BEFORE CONSTRUCTION The undersigned owner hereby agrees to hold and save harmless <br /> Ina City of Everett from any and all claims for damages, costs. <br /> ea penses.or causes of action that may arise because of Inslallallon <br /> and maintenance of the Improvement or other right of way use <br /> hereto Applied for and lurlher agrees to remove same upon notice <br /> train The City and to replete public properly damaged thereby. <br /> DEPARTMENT APPROVALS <br /> SEWER COMMUNICATIONS <br /> a, <br /> DRAINAGE TRAFFIC Y <br /> WATER — PLANNING 1 SIGNATURE OF APPLICANT <br /> STREET ADDRESS <br /> re. j <br /> !� zIP <br /> APPROVEDNRUC IONT"It <br /> VATE <br /> TELEPHONE NUMBER ry ALTERNATE <br /> PROVED AS CONSTRUCTED on lT. ' " <br />