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evcrrti <br />CITY ENGINEERS <br />EVERETT. WASHI <br />The Undersigned r 1-1 1 1' <br />Hereby applies for permission to <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />j.0?.43 <br />PERMIT NO. 75-3'T <br />At the following location rN <br />SKETCH <br />(Work to be done) <br />J <br />NO <br />r <br />SC AL E <br />A� <br />NEW ASPfIALT D/W <br />DRIVEWAY SECTION <br />NO SCALE <br />a <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 />Z,s &' !/S� _ <br />Inspector's Signature <br />Die <br />Remarks <br />Note: Original to Customer 1 Copy to File 10143 <br />1 Copy to Inspector <br />EX/ST/NG 1�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 />44 11 tion and maintenance of the improvement hereto <br />applied for and further agrees to remove same upon <br />notice from the City and to replace public property <br />I elepnone NumDer <br />J)U) �1 Date <br />Tee — <br />,Dept. <br />Dept. Approvals <br />Engineers C_ ` 3 �✓/JS <br />Water <br />Street _ <br />Communications <br />Traffic ay2 <br />Planning O <br />Ap �Y�iC+RitlwV �/.��s <br />'Date 14proved <br />