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W <br />CITY ENGINEERS <br />EVEHE"i T. WASHINGTON <br />APPLICATION FOP RIGHT-OFAVAY USE PERMIT <br />+ ,I <br />The Undersigned T! rr it N,'L �.A <br />Hereby applies for permission to , ,'mN <Tr,ir T H Z S <br />At the following location <&- 2 6 /�I� FL- V <br />SKETCH <br />(Work to be done) <br />DRIVEWAY SECTION <br />NO SCALE��. <br />I <br />I" LIP <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 2598811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />Remarks <br />Note: Original to Customer <br />1 Copy to File 1 O 911 <br />1 Copy to Inspector <br />10911 <br />PERMIT NO._ ?-1 <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 />note the City and to replace public property <br />d ag1d a—e%611 \ /\ /f <br />Signature of Ap} Wcant ` I <br />VGA ,S/Sf S%-- SZk/ /G1C�1 <br />Address <br />ma's- 6766 <br />Telephone Number <br />� — 2 -0 <br />Date <br />Fee <br />Approved by <br />Date Approved <br />