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W,-, <br />APPLICATION FOR RIGHT -OF -`NAY USE PERMIT <br />CITY ENGINEERS <br />EVERETT, WASHINGTON PERMIT <br />The Undersigned S n• Coy. 't cu cJ ,dry <br />Hereby applies for permission to < < 0 ". c S : 1 o wv ��_. _ `•Jc-t r x L� t X `I <br />At the following location :-`\0-3 (� ro.,A-- <br />SKETCH <br />(Work !a be done) <br />DRIVEWAY SECTION <br />NO SCALE <br />1 <br />I" LIP <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 159-P811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve P <br />Drainage C4� Qle <br />Curb &Gutter <br />Sir:ewalk <br />Inspector's Signature <br />—Date <br />Remarks <br />Note: Original to Customer <br />1 Copy to File 10845 <br />1 Cop:, to Inspector <br />y\u-'k R\Ckh <br />dQ/ Zv/71 <br />O <br />10845 <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 for and further agrees to remove same upon <br />notice from the City and to replace public property <br />damaged thereby. ..J1� <br />Sr^:r -_ _ J \1�+ <br />Sig a1 re of Applicant <br />Address <br />--\ —\ 8 — rN 5 `A 9 <br />Telephone Number <br />Date <br />Fee <br />Dept. pprovals <br />Engineers 1a t <br />Communications <br />Planning <br />Approved by <br />Date Approved <br />