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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />e:2ren 10864 <br />e <br />CITY ENGINEERS <br />EVERETT, WASHINGTON PERMIT NO. '77-14 9 <br />The Undersigned [ t t- n i <br />_ <br />Hereby applies for permission to -1 <br />At the following location -' / 7 r; C _ # n 3- 1.,= <br />/ AvX, <br />(Work to be donel <br />DRIVEWAY SECTION <br />NO SCALE <br />1" LIP pp I <br />30' ____--_�3 <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 259.8811- <br />24 HOURS BEFORE CONSTRUCTION <br />CHECKLIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature - <br />e <br />%/,rod" 1"►a <br />Remarks <br />Note: Original to Customer <br />1 Copy to File ] 0864 <br />1 Copy to Inspector <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. <br />Signature of Applicant <br />Address <br />Telephone Number <br />Dept. Approvals <br />Communications <br />Planning_ <br />Approved by <br />Date Approved <br />