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ki <br />Cr7Y ENGINEERS <br />E'VERETT, WAEHINGTON <br />APPLICATION FOR R'GHT-OF-WAY USE PERMIT <br />10500 <br />PERMIT NO. 7 G - /_'Z <br />The Undersigned __ C. 4.. C e I r ,_- <br />Hereby applies for permission to if? s 1,: // a 12 r A r, i- „ ; ? _ D/,,,� n ,� (•,•/„ /?- n •H. <br />At the following location_ 412 1 ✓:j r- I. r el e r F A v c <br />(Work to be done) <br />9V•yiL ^� �Lt�- 7/ <br />S�LI/EiC:CC "c`, -OH/ <br />cc. l <br />v' i N) <br />DRIVEWAY SECTION <br />NO SCALE <br />I" IP <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 259 8811 <br />24 HOUFIS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />Ste <br />Remarks <br />Note: Original to Customer <br />ICopytoFile 10500 <br />1 Copy to Inspector <br />M <br />The undersigned owner hereby agreesjjo hold and <br />save harmless the City of Everett frorh'any and all <br />claims for damages that may arise because of Installa- <br />tion and maintenance of the improvement hereto <br />applied for and f r agrees to remove same upon <br />n ice o Cf d to replace public property <br />dam e e <br />-BIg t e o pp if -ant <br />jQn7 \� �` ST C�/Upt t6M It 1+- <br />Adre55 <br />'!SCQCb-A\61\ CkeL.9C=$ <br />Telephone Number <br />Date <br />Fee �! rQ <br />/J'` Difpt. Approvals <br />Engineers <br />Water u' <br />Street r_ <br />Communications'' " <br />Traffic Ae •—� i <br />Plannin` <br />Srwer._�ni , isoi, ,t3ey <br />Approved by <br />Date Approved <br />