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n <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or prin ,early with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />i IIBLIC WORKS PERMIT NO--Y6 - S <br />EVERETT. WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY: <br />HEREBY APPLIES FOR PERMISSION TO <br />N I I I I) — � - — -• <br />X'SSacl Ak <br />DRAWING (WORK TO BC DONE) OR THREE PLANS ATTACHED: <br />i�� ± <br />C <br />65 <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO RE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-081 1 <br />24 HOURS BEFCr7E CONSTRUCTION <br />I)it N �i-fz ZL(NE <br />to L_x%S�, ►tJC.- <br />DRIVEWAY SECTION <br />30 <br />r 3-0" <br />The undersigned owner hereby agrees to hold and Be" harmless <br />me City of Everett from any and all claims for damages. llecosts. <br />rrponses. or causes of action that may arise because of tnslahon <br />hereto appedUse <br />anddce for and further to remove same ponundllce <br />l <br />from the City and to replace public property damaged thereby. <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />SEWER <br />(/�/ [ <br />DRAINAGE TRAFFIC Lf�(—�..1`� <br />PLANNING SI NATUREOFA LICAI T <br />WATER Q��� `v1 N <br />L�S� <br />STREET <br />CITYv5- 7J7� f 4-�A-=3143 <br />�� U I N dATE ALf ERNAtE <br />A VE TELEPHONE NUM(IE <br />DAIL <br />APPROVED AS CONSTRUC ED <br />OAIE <br />REFERENCECOPY FEE <br />