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[®r <br />CITY ENGINEERS <br />EVERETT•WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />11340 <br />PERMIT NO.-71^• �! <br />The Undersigned t?,'7/ pi/i/✓-,y,ig,yy� S /!b <br />Hereby applies for permission to -7 A7 G �- <br />At the following location <br />CYCT�u '�x"x'�fY. <br />(Work to be done( <br />1 <br />DRIVEWAY SECTION <br />NO SCALE <br />�---- t II'_' LIP <br />I�30 I <br />FHOURS <br />HIS APPLICATION TO <br />ON JOBSITE. <br />INEERING DEPT. 259 8811 <br />BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />Remarks <br />11340 <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 />A <br />Signature of Applicant <br />Address <br />Telephone Number <br />L Y�f <br />Date <br />Dept. Approvals <br />Communications <br />Approved by <br />INSPECTOR'S COPY Date Approved <br />