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APPUCATION FOR RIGHT•OF-WAY USE PERMIT <br /> .. everet7 .�. .� . . . _ <br /> � � <br /> CITY ENGINEERS <br /> EVERETT,WASHINGTON PERMIT N0. <br /> The Undersigned ' ' <br /> Hereby applies for permission m � � � � � <br /> . - . .1, i i r. <br /> At the following location ' � � <br /> SKETCH <br /> (Work ro be done) <br /> � K, <br /> ��� � <br /> �� � � <br /> � <br /> DRWEwnY SECnON The undersigned owner hereby agrees ro hold and <br /> NO SCaLE save harmless the City of Everett from any and all <br /> f" . ' -� claims for damages that may arise because of installa• <br /> I" LIP tion and maintenance ot the improvement hereto <br /> applied for and further a9rees to remove same upon <br /> I 39" I _ ___ _ __ 1 30"� notice from the City and to replace public properry <br /> �`--..1� �1' <br /> � damaged thereby. <br /> Signature of Applicant " <br /> COPY OF THIS FlPPUCATION TO Address - <br /> BE POSTED ON JOBSITE. Telephone Number <br /> CALL ENGINEERING OEPT. 259-8871 � - <br /> 24 HOURS B[FORE CONSTRUCTION Date <br /> CHECK LIST Fee <br /> Waier vaive Dept. Approvals <br /> Drainage <br /> Curb& Gutler Engineers � � � <br /> Sidewalk Water <br /> Street_ <br /> Communications <br /> Inspecmr's Signawre Traffic <br /> Planning <br /> �te <br /> Remarks <br /> Approved hy <br /> Date Approved � <br />