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everefl <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT. WASHINGTON PERMIT NO.� <br />APPLICANT (UNDERSIGNED) AND FIRM RE, RESENTED. IF ANY: "):F <br />HEREBY APPLIES FOR PERMISSION TO— <br />It - <br />AT THE FOLLOWING LOCATION____ % N <br />DRAWIN ; (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />� <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON : OBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRU(;TICIN <br />SEWER <br />WATER <br />DEPARTN"ENT APPROVALS <br />COMMUNICATIONS <br />TPAll IC <br />ANNING <br />APPROVED FOR CONSTRUCTION DATE <br />APPR VEDASC0Ni1ntJr TFn OATE <br />DRIVEWAY SECTION <br />f r LIP <br />L 30•T � 30" <br />The undersigned owner hereby agrees to hold and sous harmless <br />the City of Everett from any and all claims for damages. costs. <br />expenses. or causes of action IhA may arse because of Installation <br />and maintenance of the Improwmenl or other light-Ohway use <br />harsh, applied for and Willie, agre.9 10 remove same upon -notice <br />from the City and'to replace publlr ..•noerty damaged thereby. <br />/) <br />ree. <br />/ <br />51GNAT URE 0 <br />PPLI ANY r <br />ADD Ea5 <br />9-=2e— <br />CITY LIP^ <br />-4 15- i <br />TELEPHONE NUMBER ALTERNATE <br />2-?i - ri <br />