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ev(retl <br />CITY ENGINEERS <br />EVEHETT, WASHINGTON <br />The Undctsigned <br />Hereby applies fo <br />APPLICATION FOR R1131IT-OF-WAY USE PERIAIT <br />At the following locatinn_ <br />SKETCH <br />(Work to be done) <br />-Z <br />a <br />DRIVCWAY SECTION <br />NO SCALE <br />11" LIP / J <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON.IOBSITE. <br />CALL ENGINEERING DEPT. 2598811 <br />24 HOURS BEFORE CONSTRUCTION <br />CIIECK LIST <br />Watm Vals_e _ <br />Drainage Cm-b & Gutter_ <br />Sidewalk <br />Irepeck: is Signature <br />i <br />Rornarks <br />Note: Original In Cuctamer <br />i 1 Copt' to i de.. <br />1 Cupy to Inspector i ;l <br />PERMIT NO. i <br />ac )Ts-" �oeru. n.4 W Ut C-ec'o e -t. q 0 <br />bt <br />,�AWcI%I <br />I• ��lr �— <br />GRAN,p <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and all <br />claims for damages chat may arise because of installa- <br />tion and maintenance of the improvement hereto <br />applied for and further agrees to remove same upon <br />40 notice from the City and to replace public property <br />damaged thereby, <br />—!-c.._ <br />Sig a ura of Applicant <br />Via . <br />Address <br />Telephone Nuinber <br />Date <br />Dept. Approvals <br />Engineer <br />Communications---- <br />7raffic�--------- <br />P:anning-- '-- ------- -- <br />Appros �•e by <br />I <br />i <br />