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e���an <br />� <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />APPLICATION FOR RIGHT•OF-WAY USE PEitMIT tit`. <br />11103 <br />PERMITNO._ 7a— � 7 <br />The Undersigned <br />Hereby applies for pertnission to f u,-� •. �,' 't �� �o �� C, �'/�.0 -{-�, E � r � ��S � F <br />At the following location <br />(Work to be done) <br />DRIVEWAY SECTION <br />NO SCAIE <br />� � 5' --- --� <br />I" LIP � <br />�..30'J.--- .� __._ .__ _�•30"� <br />I COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL E^!�INEERI�G DEPT. 259-8817 <br />24 HOU �S BEf'ORE CONSTRUCTIOIJ <br />CHECP LIST � � <br />Water Valve �� � ' <br />Drainage " � � <br />Curb & Gutter - <br />Sidewalk <br />/� ��- <br />cter's Signature <br />�•-Z� - �; a <br />ate <br />Remarks <br />11103 <br />INSP[CTOR'S COPY <br />The undcrsigned owner hereby agrees to hold and <br />save harmless the City of Everett irom any and all <br />claims for damages that may arise because of installa- <br />tion and maintenance of the improvement hereto <br />applied tor and further agrees to remove same upon <br />notice (rom the City and to replace public properry <br />damaaed thereby. <br />SignaWre of Applican[ — - <br />�'�i�'% . .,_ . - <br /><< <br />Address <br />.. /�i•:c::� <br />Te�ephone Number� , -- <br />- ... _. -. ..- . -r ��. <br />Dept. ApproSals <br />� , . ! _ �..Y-- I <br />Engine,^.rs- �'�Lilr ' � �� �; l.1 ' i� � <br />Water \ <br />Street_ �_��. _ <br />Communications ��,� <br />_ \ <br />Traffic '\ <br />,� — <br />Planning \., <br />\, <br />_ �� <br />Approved by_ � � �_ ���' �� � . <br />'1i�irt� ...I....� It ��; i. <br />Date Approved ; � �. B <br />