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ki <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print Clearly With ink <br />CRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS L <br />EVFRET r. WASHINGTON PERMIT NO, J <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY. Ctjlog1,gry r /Q/G <br />HEREBY APPLIES FOR PERMISSION TO - <br />AT THE FOLLOWING LOCATION <br />DRAWING (WORK (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FOR 60 DAVS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSfrE. <br />CALL FOR INSPECTION 259-661 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />SF W ER COMMUNICATIONS <br />DRAINAGE <br />WATER //PLANNING/ 1 <br />St"EEr 1 1L— `-1 — / -- <br />���q./�y <br />APPROVED FOR COMISTIrIPLINDATE <br />A l,0 <br />APPROV 15 CO T �T DATE <br />DRIVEWAY SECTION <br />rI <br />I� jI" LIP <br />The undersigned owner hereby agrees to hold and save harmless <br />me City of Everett from any and all claims toy damages. coals. <br />ponses. or causes of action that may arise because of installation <br />.vn) mM ntenance of the Improvement or other Itghb Of -Way use <br />herplo applied for and further agrees to remove same upon nonce <br />from Ina City and to replace public properly damaged thereby. <br />/�GNA RJnE Or APnL�GNT A <br />Annnc�c <br />Crtr DP <br />TELEPHONE NUMBER ALTERNATE <br />//7/tea <br />DA <br />CONSTRUCTION/AS BUILT <br />1978 <br />