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~ APPLICATION FOR RIGHT-OFWAY USE PERMIT <br /> everetl <br /> e zosao i . <br /> i <br /> CITY ENGINEERS �'� <br /> EVERETT,WASI;INGTON PERMIT N0. �,' •' � I <br /> — I <br /> The Undersigned�i_ + � � � �,.i� � l� <br /> i Hereby applies for permission to ./•- •, i � — .: a j' '� „/ : � —�r � .� <br /> � <br /> I At the following loca[ion /// 2 C i(,�� V j) <br /> SKETCH I' <br /> , (Work to be done) <br /> �� ," :'� i r� �. .� =�J i <br /> I <br /> i II <br /> I I <br /> � , I� <br /> � <br /> I <br /> I <br /> I <br /> I <br /> I • i <br /> � ��'� . . . Li.r- . .� ,'.C.k"�' � <br /> I <br /> DRIVEWAY SECTION The undersigned owner hereby agrees to hold and i <br /> , NO SCnLE save harmless the City of Everett from any and all ' <br /> r-- � claims for damages that may arise because of installa� i <br /> 1 Y' LIP� tion and maintenance of the improvement hereto I <br /> ' L�3�0� �,y� �� I 30, applied for and further agrees to remove same upon <br /> � '_ T '------�-'�1"� notice from the City and to replace public property ' <br /> damaged thereby. <br /> Signature of Applicant � <br /> . �COPY OF THIS APPLICATION TO I Address <br /> BE POSTED ON JOBSITE. I , I <br /> CC lL ENGWEERING DEPT. 259�881� � Telephone Number <br /> i � % � <br /> I24 HOURS BEFORE CONSTRUCTION� Date , . <br /> ------- "� . , �"��. <br /> CHECK LIST Fee � <br /> Water Valve <br /> D�ainage �pt. Approvals <br /> � Curb&Gutter . Engineers �- �� <br /> I Sidewalk <br /> �� �j�' � / Water <br /> ' l�l � Ce %",." . l�"� ,� �` •����♦ Street <br /> Communiwtions <br /> Inspector's Signature . <br /> Traffic <br /> Planning <br /> —6ate <br /> Remarks <br /> ' Note: Original to Customer � <br /> 1 CoPY to File � �Ci�1 p � <br /> 1 Copy to Inspector Approved by <br /> Date Approved <br />