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I everetl r <br />er <br />CITY ENGINEERS <br />EVERETT. WASHINGTON <br />The Undersigned ' /7 , <br />Hereby applies for permission to <br />At the following location <br />(Work to be done) <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />10388 <br />PERMIT NO <br />I CAnlVi�S ,�filXCy�� <br />r <br />1 <br />it LGNC- ;C.IIM,.� �_— <br />/7c Y✓r j i <br />j / ,�.9/L✓A;G <br />I i a <br />No m <br />.SEE .4rrAGNr60 <br />sxe-rc"yes 6�-, <br />DRIVEWAY SECTION <br />NO SCALE <br />I <br />I'LIP <br />COPY OF THIS APPLICATION TU <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 259.8811 <br />24 HOURS BEFORE CONSTRUCT N <br />r <br />CHECK LIST <br />Water Valve N <br />Drainage <br />Curb &Gutter j 1 <br />Sidewalk � _ , <br />Remarks <br />Note: Original to Cu! tomer <br />1 Copy to File 1.0388 <br />1 Copy to Inspector <br />L� <br />r <br />I_ <br />- 7 <br />t. <br />I <br />1, <br />t J ti <br />The undersigned owner hereby agrees 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 follfand further aarees t<remove same upon <br />notice frofn the City n Ic property <br />dam ,�ge�d thereby. � <br />Signature of Applicant <br />�,170 I+cw,T <br />Address <br />.:�52— 11'2,ej <br />Llephone Number <br />fi c-[Io 7u,iril to <br />Date <br />Approved by <br />Dept. Approvals <br />u <br />I <br />Date Approved <br />