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everetl <br />� <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />The Undersigned ' <br />Hereby a�Plies for permission t�� <br />At the following <br />(Work to be done) <br />kPPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />DRIVEWf+Y SECTION <br />NO SC1LE <br />�--- --- — - — —� <br />I'� LIP <br />�,.30�__ _ ___ I 30 I <br />T �1 <br />� COPY OF THIS APPLICATION TO � <br />�I IiE POSTEp ON JOBSITE. <br />� r,:.LL [NGIN[6qING DEPT. 259�081 t <br />�,'��7 r{�'II�ItS RLFORE CO��.;STFUfTIJfJ�� <br />—� <br />�ate — <br />Remarks <br />Note: Onginal to Customer <br />1 CopY ta File ' i <br />� r �r <br />, copy to �osp�,clor � <br />; l � ; r�, i.� �, � . , <br />�0/10 <br />PERMIT NO. <br />The undersigned owner hereby agrees to hold and <br />save haimless the City of Everett from any and all <br />claims for damages that may arise because of installa� <br />tion and maintenance ot the improvemerc hereto <br />applied for and furiher agrees to remove same upon <br />notice from the City and �o replace public property <br />damaged thereby. <br />ign���– eture�Df-Applican[ -� <br />� � ,. ��f'T� .. <br />Address ' <br />r� � <br />Telephone Number � <br />;� o � <br />Date <br />� � i !� J <br />Dept. Approvals <br />Engineers � � -- <br />Communications <br />Annroved by <br />Date Apprcved <br />