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APPLICATION ✓FOR RIGHT-OF-WAY USE PERMIT t <br />wcrctl 1 � _ 1 <br />ITY ENGINEERS PERMIT NO. <br />VERETT,WASHINGTON <br />he Undcrsig,,:d <br />erehy applies' or permission to <br />t the following location <br />KETCH <br />Vork to be done) <br />SEE F77�4cNE0 <br />DRIVEWAY SECTION <br />NO SCALE <br />jI" LIP <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 259-8811 <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 />ICopy toFile �.�L�.,. <br />1 fupv 10 Inspector <br />The undersigned owner hereby agrees to hdd and <br />save harmless the City of Everett t,om any and a'I <br />claims for damages that may arise because GI imtalla- <br />tion and maintenance of the improvement hereto <br />applied for and further agrees to remove same upon <br />no iee.fro+) the City and to replace public property <br />dragcd hereby. <br />Signature of AppriC31 t <br />Address <br />—� % C <br />Telephone Number <br />Date L <br />Fee <br />Dept. Approvals <br />Wate <br />Commune ations <br />Approved by <br />