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everetl <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />10061 <br />PERMIT NO. <br />The Undersigned lJ o H t"1 C't . S A. Lg� S. <br />Hereby applies for permission to Pt L]D D ti 1 O S ^TL Eu\ T, fl121yC7 A 4 <br />r. <br />At the follov.:ng <br />(Work to be done) <br />�-}OI_nS{aoo jC AVM <br />P <br />V) <br />DRIVEWAY SECTION <br />NO SCALE <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 259.8B11 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter n' <br />Sidewalk <br />Inspect//jj ign ure (� <br />(%' 1 / <br />ate <br />NO <br />S(ALF <br />I ne unoersignea owner nereny agrees to nola ano <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 for and further agrees to remove same upon <br />otice frjQm the City and toO lace p blic property <br />a a e hereb <br />/ <br />Si ature of pp ica t <br />Address c '/ <br />1-) 2- <br />Telephone Number <br />Date <br />Fee lye <br />Remarks <br />Note: Original to Customer <br />1 Copy to File 1 0 0 61 <br />1 Copy to Inspector Approved by <br />Date Approved <br />