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evercll" <br />� <br />CITY ENGINGERS <br />EVFftETT, WASHINGTON <br />The Undersigned <br />Herehy applies for permission to <br />At the following loca[ion= <br />(Work to be done) <br />APPLIC aTION FOR RIGHT•OF-WAY USE PERMIT �•--, <br />(`� �. � 876 <br />� <br />i DRIVEWAY SECTION <br />I NO SCALE <br />I � � <br />I ( ��� LIP � <br />, 3�..+.__ .. ��"30,� <br />i <br />e <br />PERMIT <br />Fi --,; ,, -,. <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and all <br />claims for dama9es that may arise because of installe� <br />tion and maintenance ot the improvement hereto <br />applied or and further ap ree o rem� e� }�ame upon <br />notiGe f m the City anb re lacdpublfc property <br />a,..l ...;a .�.,....�... / / / . /� <br />i -- ���7� ? 61r,clY y.�' �' - <<ti� <br />�COPY OF THIS APPUCATION TO Adclress _ --�L� <br />6E POSTED ON JOBSITE. � �� ���� <br />i Telephone Number � <br />CALL ENGINEERING DEPT. 259�8811 —� _ � � <br />� 2�! I-IOi�RS BEf-ORE CONSTRUC�ION Date / L <br />� -- -- ---- --- ---- <br />CHECK LIST 1 , Fee v <br />'�� Water Valve ?'� �� �!/A���,�� "y <br />' Drainage 'y ��'=� !v�` ,;�q�,( ;r , �/ Dept. Approvals <br />Curb & Gutter d 6:��Engineers � <br />� Sidewalk ' ` <br />Water <br />Inspec[or's Signature <br />Remarks <br />Note: Original to Customer <br />1 Copy to File ' ^' <br />1.(,,; <br />1 Capy to Inspector <br />Street <br />Communication�_ <br />Approved by <br />Date Approved <br />�- I <br />