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everett <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT 11156 <br />The Undersigned �.te.�. 0 -_ __..'_tee--,__j <br />Hereby applies for permission to Z — 2. I I ' . o f' % /1r.' ' <br />PERMIT NO._ <br />At the following location —7 I .!, CS %i ..2 J - ' % ' _ <br />(Work to be done) <br />DRIVEWAY SECTION <br />NO SCALE <br />I" LIP <br />IV <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 259-8811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECKLIST <br />Water Valve <br />Drainage ' �_-- <br />Curb & Gutters <br />Sidewalk <br />Inspe r'sSi PatGre <br />3Io(--,C <br />ate <br />I /J <br />Remarks f e �- <br />qxt>` �1115 6 <br />ply IF <br />INSPECTOR'S COPY <br />i <br />ii <br />I <br />I <br />1 <br />� <br />7 i <br />I I <br />The undersigned owner herebyagrees 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 />damaged thereby. <br />Signature of Applicant <br />Address r'4>�- <br />Telephone Number <br />�•� i R' <br />Date <br />Dept. Approvals <br />Communications <br />Approved by <br />Date Approved „r_ 9 <br />