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everetl <br />11 <br />CITY ENGINEERS <br />EVERETT.WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />n <br />10562 <br />PERMIT NO. 76 - / SS <br />The U"idersigned 1 _1 /-1 e, r r i c n 11 <br />Hereby applies for permission to r r n r c f r: 1? /I s v h r/ r DIIN r, n <br />At the following location 1 S 18 A17 V ; r n in ; t; `;'t . <br />SKETCH <br />(Work to be done) <br />"'I <br />i <br />TO center <br />of MH on <br />Ibr='sr. <br />IF-18 <br />A le 13 <br />match 011ey pav;n9, <br />;F any, <br />DRIVEWAY SECTION <br />NO SCALE <br />f.- 19'------1 <br />11" LIP / I <br />COPY OF THIS APPLICATION TO <br />BE POSTED CN JOBSITE. <br />CALL ENGINEERING DEPT. 259 8811 <br />24 HOURS 81:FOnE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspectors Signature <br />Da ; <br />Remarks <br />Note: Original to Cu.tomer <br />1 Copy to File 1,0562 <br />1 Copy to Inspector <br />I P/L <br />Ho SCOIL <br />,galh $/2'�76. <br />n t <br />Is <br />P/L <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 />lion and maintenance of the improvement hereto <br />applied for and further agrees to remove same upon <br />notice from the City and to rep'ace public property <br />damaged thereby <br />Signature of pplic t <br />Address <br />Telephone Number <br />Date V f.r <br />Fee <br />- /DDept. Approvals <br />Engmeer,/ <br />Water <br />Street .✓" Y� <br />Communicdi, ins <br />Traffic�y-�y-_c.. <br />Planning <br />Approved by <br />Date Approved <br />