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everett <br />e <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />APPLICATION FOR RIGHT-OF•WAY USE PERMIT <br />10936 <br />, <br />PERMIT N0. � / �: � � <br />The Undersigned � �� � ��i�= � � � <br />Herebv applies for permission to ( oniSY? v� r A ' ti� /jSPNA [- T 5��� <br />At the following <br />�n� i �.n <br />(Work to bc done) <br />x <br />. � DRIVEWAY SECTION <br />NO SCALE <br />F--- ----- � <br />�I,� LIP � <br />30'y___— —___—�30"..I <br />COPY OF THIS APPLICATION TO �i <br />' F3E POSTED ON JOBSITE. ' <br />. CALL ENGINEERING DEPT. 259�8871 �, <br />. 24 HOURS B[FORE CONSTRUCTIO��I I <br />CHECK LIST <br />. Water Valve <br />Drainagc <br />� Curb & Gutter <br />Sidewalk <br />' Inspector's Signature <br />, n��� <br />Remarks <br />Notc: Original to Customer <br />, , �o�Y to F��� 1. (19:� 6 <br />, 1 Copy to insPector. <br />� : �� �� i i.=•i(�' r4:="A <br />The undersi9ned owner hereby agrees to hold and <br />save harniless the City of Everett from any and all <br />claims for da iges that may arise because of installa• <br />tion and mai�enance of the improvement hereto <br />applied for an further agrees to remove sa c u on <br />notice frorq e Ciry and to gplace py�bl��rty� <br />Address <br />3S`S = i� <br />Telephone D�u b.�r <br />Da.e `—S �� <br />i� � <br />Dept. Approvals <br />y . <br />, <br />En9ineers_ � d �C� e r- <br />Strcet <br />Communications <br />Approved by <br />Date Approved <br />� <br />j I <br />