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- CVlrCN <br />CITY ENGINEERS <br />EVERETT. WASHINGTON <br />The Undersigned <br />Hereby applies fa <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />�10121 <br />PERMIT NO. 75 /o <br />At the following location /B// DOLL PL= <br />SKETCH <br />(Work to be done( <br />NO —CeQ.F <br />DRIVEWAY SECTION <br />NO SCALE <br />�--- 27 ~1 <br />-TN-Up <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 259-8811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />/ <br />Inspector' S' nature <br />Date <br />Remarks <br />Note: Original to Customer 0 <br />1 Copy to File <br />1 Copy to Inspectot <br />AL T D/W <br />QF <br />G 10AVEMENT <br />42The <br />undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from 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 further agrees to remove same upon <br />notice from the City and to replace public property <br />dargaged th rebti� <br />Signature of Applicant <br />�dsyN <br />?Nail <br />ddress�y T <br />Address,,,,._,, <br />, <br />F��,,._ <br />Telephone Number <br />Date <br />Fee / .3. � U rLe.t�Et• �� IX — %((-' <br />Approved by .� <br />Date Approved 2 -7 <br />r <br />