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ki <br />CJT)' ENGINEERS <br />EVERET-r, WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />10882 <br />PERMIT NO. 7 2'1 2 Y <br />The Undersigned _FloOrLL SCh Uf NA, r7 <br />Hereby applies for permission to r L oSe" AL Lt 0/ — <br />At the following location 5rl2- /-j,3 I/T <br />(Work to be done) <br />DRIVEWAY SECTION <br />NO SCALE <br />f - <br />I" LIP <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 259.8811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb 6 Gutter <br />Sidewalk <br />Inspector's Signature <br />Remarks <br />Note: Original to Customer <br />1 Copy to File 10882 <br />1 Copy to Inspector <br />The undersigned owner hereby agrees to hold and <br />savc 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 />AZJ <br />Signature of Applicant <br />a sa 2 MA Ale I!/N P,f 201 <br />Address <br />Qs'2 Gd <br />Telephone Num%br <br />s/y r <br />Date �n ' <br />Fee ' <br />Dept, Approvals <br />Engineers L� -i✓i._ <br />Street _ _ <br />Communic�lC s <br />Traffic— <br />Planning — <br />Approved by <br />Date Approved <br />