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APPLICATION FOR RIGHT•OF-WAY USE PERMIT <br />_ everetl <br />�.,i <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />The Undersigned <br />Hereby applies for permission to <br />At the following loca[ion ��i9 �% % : � �- <br />IWork to be done) <br />. . . � � �. %� r �l <br />DRIVEWAY SECTION <br />NO SCALE <br />� � <br />I'� LIP <br />�, 30 +—. _—.— __. _ _�i' 3�1 <br />� I;OPY 06 71IIS nPPLICATIOhI l O �� <br />I SC- POSTGD ON JOBSII -L . <br />� CALL EIVGINFEftING DEPT. 259�8811 <br />;'�1 HC?I:I'�5 CSEFORF CONSTRUt:I I�:�1 <br />CHECK LIST <br />Wator Valve <br />Drainage <br />CurL & Gu[ter <br />Sidewalk <br />1 nspector's Signatr.re <br />; '. <br />Rr.marks <br />Notc: Oriyinal to Customer <br />t CoPY to File '� � %�'-, � <br />1 Copy to Insper.tar <br />'�350 <br />PcRMIT NO.� -� <br />� � . <br />The undersigned owner hereby agree: to hold and <br />save harmiess the City o( Everett (rom any and ail <br />claims for damages that may arise 6ecause of installa� <br />tion and maintenance o( the improvement hereto <br />applied for and further agmes to remove same upon <br />notice from the Ci;y and ro replace public property <br />dama5ed.thereby. .. � .!,�'� -:'1;%.�� . <br />- � , ✓ %l <br />Signawre of Applicant ' ^—���� <br />, . ' . . �!'" _ <br />Address � , . <br />- % � <br />Telephone Number � <br />Plann <br />Approved by <br />Date Approved <br />Dept. Approvals <br />� <br />