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CITY ENGINEERS <br />EVERETT.WASHINGTON <br />APPLICATION FOR RIGHT-OFMAY USE PERMIT <br />10907 <br />PERMIT NO. ' 41 <br />The Undersigned MplzrH /'.94ST CoricTK✓cTioa/ Po <br />Hereby applies for permission to Cam l SYKue f 7WX �5) L✓•SYNA�� /i�w 't — /— 27 �-- I —2 '=� <br />/- 30, <br />At the following location 5- !Fr,,7)AC2VIIAJ 4Cin/FrnA � V. 'VZ) rV :!e—'T M;AGE <br />(Work to be done) <br />SEE ATA e/fe0 <br />=_ =,ajen <br />. DRIVEWAY SECTION <br />The undersigned owner hereby agrees to hold and <br />NO SCALE <br />save harmless the City of Everett from any and all <br />claims for damages that may arise because of installa- <br />I" LIP <br />tion and maintenance of the improvement hereto <br />applied for and further agrees to remove same upon <br />from <br />notice the City and to repjace public property / <br />�/Llk <br />d�a%ag�ed�th�erei,/y� <br />jy-a(; � LA, <br />(��t LT <br />/Y-�Jc:irte <br />o �S--tcant <br />' Signature of Applicant ��irZLII� <br />2 C; 1 £,9,0i7) <br />COPY OF THIS APPLICATION TO <br />, <br />Address <br />BE POSTED ON JOBSITE. <br />_364 o h <br />CALL ENGINEERING DEPT. 258 8811 <br />Telephone Number <br />24 HOURS BEFORE CONSTRUCTION <br />Date i—i9 <br />CHECK LIST <br />l�63 tEt r — <br />- <br />Water Valve <br />Drainage <br />.Fee <br />Dept. Appr Vals <br />f j• <br />Curb & Gutter <br />Engineers <br />Sidewalk <br />_ <br />Water _ <br />Street _ <br />Communications <br />Inspector's Signature <br />_ <br />Traffic _ <br />Planning <br />Date <br />Remarks <br />Note: Original to Customer <br />1 Copy to File 1. 0 !D 0 7 <br />1 Copy to btspector <br />Approved by <br />At <br />Date Approved <br />