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W <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />10759 <br />PERMIT NO. <br />The Undersigned C'hr' 0 eg9ey'Al/ iZ <br />Hereby applies for permission to <br />At the following location 3 R-N 5 r — <br />(Work to be done) <br />56er 47—/ �14 cN;o <br />DRIVEWAY SECTION <br />I� NO SCALE <br />I tl LIP <br />f 30" 1 <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 />Date <br />Remarks <br />Note: Original to Customer <br />1 Copy to File 10759 <br />1 Copy to Inspector <br />The undersigned owner herebv agrees to hold and <br />save harmless the City of Everett from any and all <br />claims for damages that may arise because of installs <br />lion and maintenance of the improvement hereto <br />applied for and further agrees to remove same upon <br />rfotice from the City and to replace public property <br />damaged thereby./Jr�'1 - ,Q <br />Sighe$re of Aoplicant <br />%4/O / li>rif�irT.� GJra <br />Address <br />S S - 7 7C90 _ <br />Telephone Numb r <br />b _ <br />Date ' <br />Fee <br />Dept. Approvals <br />C � <br />Engineers <br />Water bar <br />Street —/l ZL' ,' - /-17 <br />Planning <br />Approved by <br />Date Approved <br />