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everetl <br />� <br />CITY ENGIf1EERS <br />,�EVE3E"fT, WASHINGTON <br />� The Uodersig+ied _ <br />Hereby applies for permission to <br />At the following loca[ion <br />(Wori; :o be done� <br />APPLICATION FOR RIGHT•OF-WAY USE PERMIT <br />�-c ��� -�c� . <br />PERMIT <br />�RIVEWAY SECTION <br />NO SCALE <br />I' �-� - - �I <br />+I'� LIP / � <br />�0 �—_—_—._—_ __--��30,� <br />COPY OF THIS APPLJCATION TO I <br />BE POSTED ON JOB�'ITE. <br />CALL EfJGINEERING DEPT. 259-8811 <br />24 HOURS �EFORE C�NSTRUCTION <br />CHECK LIST <br />Water Valve � <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />nspector's Signature <br />Remarks <br />, , <br />� ; <br />� ,� r <br />.�___! �J <br />The undersigned owner here6y agrees to hold and <br />save harmless the City of Everett trom 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 fiom the Ciry and to replace public property <br />damaged thereby. <br />Signature of Applicant . <br />i <br />Address � , . , <br />Telephone Numb(er <br />1'` J <br />Date <br />Dept. Approvals <br />Ccmmunications ���-_ <br />Approved by �'. � i �� � ... - . . <br />Date Approved ' `� <br />