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everett <br />�� , � <br />� CITY ENGINEERS <br />EVERETT,WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />i.1250 <br />' `i, <br />PERMITNO. ' /� <br />The Undersigned _ � � <br />Hereby applies for permission to � � _ ' -' - � -� -� i " '� �-� " +- '. `.�: � :' � '-�-" '�. - • �i r ) <br />� <br />E. <br />At the following location <br />SKETCH <br />(Work to be done) <br />DRIVEWAY SECTION <br />NO SCAI.E <br />r --- -� <br />� ( I° LIP <br />L30'� __ _ I 30"�I <br />i- '1' <br />C�PY 01= IHIS APPLICF�TION ��0 <br />BE POSTED ON JOBSITE. <br />CALL EiVGINEERING DEPT. 259�8811 <br />24 HOURS BEI'ORE CONSTRUCTION <br />CHECK LIST <br />Water Valvc <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspecto Signawre <br />S'- fipR- 7 9 <br />�ate <br />Remarks <br />t . -, r <br />� I <br />1 I � ,li <br />I <br />,� <br />� w, <br />��1c F �- `� <br />--�..�-�-c.�r�; <br />The undersigned owner here6y agrees to hold and <br />save harmless the City of Everett from any and all <br />claims for damages that may arise because ot installa� <br />tion and maintenance of the improvement hereto <br />.pplied (or and turther ac�rees to remove same upon <br />notice from the City and to replace public property <br />damaged thereby. <br />Sig�ature of Applicant <br />Telephone Nun•ber <br />Comm <br />Approved by <br />Datc Approved <br />Dept. Approvals <br />