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everen <br />�e <br />CIT�' ENGINEERS <br />EVERETT.WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />i <br />The Undersigned /� /� V�y /-(- i' �7 <br />Herebyappliesforpermissionto ',�Q/�%'f'�/i'' ' Z.- Z.i��(�,,.zi%.'= ."f i����% S <br />11047 <br />PERMIT N0. �' 3 <br />At the following location � / /� %�/i /^' �' i � f'� ��� <br />(Work to be done) <br />.- � • �,�„ <br />.5L'r :-i%/� '✓� ��� <br />� DRIVEWAY SECTION <br />� NO SCALE <br />� � � <br />� I�� lIP <br />��I 30'�___ _ I _ 30';J <br />i -t <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL [NGIN[ERING D[PT. 259�8811 I <br />24 HOURS l3EPORG CONSTRUCTIONi <br />CHECK LIST <br />Water Vaive <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />Remarks <br />Note: Originai to Customer <br />t conv �o F�i� 11 n 4 7 <br />1 Copy to Inspector <br />The undersig�ied owner hereby agrees to hold and , <br />save harmless the Ciry of Everett from any and all � <br />claims lor damages that m;y arise because of installa• , <br />tion and maintenance of the improvement hereto '. <br />applied (or and further agrees to remove same upon i <br />notice from the City and to repiace pubtic property ��. <br />/�J — 2 ti �J <br />Date <br />Fe�s�. � <br />��� <br />Dept. Approvals <br />Engincers � ����% ' <br />Communications <br />Planning_ <br />Approved by <br />Date Approved <br />