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APPLICATION FOR RIGHT-OF-WAY USE PERMITType or print clearly with ink <br />averelt <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT, WASHINGTON PERMIT NO. <br />APPLICANT (UNDERSIGNEF ) AND FIRM REPRESENTED, IF ANY: <br />HEREBI �1'PLIES FOR PERMISSION TOrA ��� <br />I nil��7py it,ut•- 1V _i6��j <br />-1 _ <br />AT THE FOLLOWING LOCATION . 4 .� t , s- . f' <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />oil el.,4 <br />'A4 %-&( 4'--/4e-0MW z!P <br />PERMIT iS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-681 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWEn <br />DRAINAGE <br />STREET <br />DEPARTMENT APPROVALS <br />COMMUNEATIONS <br />TRAFFIC <br />PLANNING <br />AISROVED FOR CONSTRUCTION DATE <br />APPROVED AS CONSTRUCTED DATE <br />INITIAL INSPECTION REQUESTED <br />DRIVEWAY SECTION <br />Ill LIP <br />30,r <br />The undersigned owner ` reby agrees to hold and save harmless <br />me City of Everett Iron .ny and all claims for damages, costs. <br />expenses. or Causes of act on that may arias because of installation <br />and maintenance of the Ilnprovemenl or other rlghl-ofway use <br />hereto applied for and furl'rer agrees Ip remove same upon notice <br />from the City and'to replace public properly damaged IhmeEy. <br />SIONATUREO PPII ANI <br />AD�ii 1" 222 <br />D ESB - <br />CITY (IP <br />M1 'SAS— i,7en <br />TELEPNOND NUMBER ALTERNATE <br />J9UA E 21 — -- <br />FEE 197D <br />