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APPLICATION FOR RIGHT-O['�WAY USE PERMIT
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<br /> CITY ENGINEERS f ' �
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<br /> � DRIVEWAY SECTION � The undersigned owncr hereby agrees lo hold and .
<br /> NO SCaLE /�C,''� �'(�- save harmless the City ot Everett irom any and all ..
<br /> f. jr'j' ----- —� 1 , � ' claims tor damages that may arise because ot installa
<br /> p�J�"� /;��=' tion and maintenance oi the improvement hereto
<br /> I" LIP �� '� applied for and further agrees to remove same upon :
<br /> 30'�„_�_�Q� .4„30�� �� �/ '(p notice trom the Ciry and to mpl •e public properiy .,
<br /> i 0� damaged ereyb �'
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<br /> Sigrt/3ture ot Appiica/� /' I
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<br /> '' COPY OF THIS APPLICATION TO � Address � " �
<br /> � �E POST[D ON JOBSITE. I �S _ �� 3 � I
<br /> ' Teieph6ne Number
<br /> �ALL GNGINEERING UEPT.259-881 I i � - �
<br /> I24 Ii�I1R:; f3FPORE C,ONSTRUCTION� . �Cee ��y� ��� �
<br /> CHECK LIST '.
<br /> Water Valve De t. proval I
<br /> ' Drainage I% ^aE/�� i
<br /> � Curb &Gutter Enginee ='Ci i
<br /> Sidewalk 1 Water �h��" � �rrf,e �,d ��
<br /> ` ��v�= ` Street �l.; •
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<br /> �� - � Communications /-�� .�2�� �
<br /> Insp9Cto 's S gnatura Traific � � " - �
<br /> � / � Plannin / ,. /.J � �' '
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<br /> Note: Original to Customer +S i
<br /> � i CopY to File 1.��5 2 '�, �n �
<br /> 1 Copy to Inspecror Approve �, / ,�/� �
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<br /> Date Approved
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