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everetl <br />� <br />CITY ENGINEEHS <br />EVERETT, WASHINGTON <br />The Undersigned /l� � i . � � <br />Hereby applies for permission to _ <br />'� <br />At the following location__;� �t; <br />' (Work to be done) <br />APPLICATION FOR RIGHT•OF-WAY US'c PERMIT <br />� E t� G�8�6 11Q66 <br />PERMITNO. �� � <br />," .� .-t-. ..�... ' <br />DRIVEWAY SECTION <br />NO SLALE <br />�--- ---- ---+� <br />I'� LIP <br />�30y___--__—__ ._�t'3� <br />� CUPY OF THIS nPPUCATION TO I <br />'�, f3[ POST@D ON JOBSITE. � <br />��, Cl1LL LNGWEGRRJG UEPT.26J�Sf311 <br />�:'4 110UiiS H[FORE CONSTRUCTION'� <br />CHECK LIST <br />Water Valve . <br />Drainage �� ���� �O� � � <br />Curb & Guttcr /� Py � S 1'e r 3�� q�j� <br />Sidewalk _ � <br />��z •��7� <br />at�e <br />nemarks <br />Note: Oriyinal to Customer <br />7 Capy to File i�� �'� r� i� <br />1 Copy to Inspec�or " ; <br />.... � .J ,� , r. . <br />The undersigned owner hereby ; �s to hold and <br />save harmless the City of Everett om any and all <br />claims for damages that may arise because of installa� <br />tion and maintenance of the improvement Lereto <br />applied (or and lurther agrees to remove same upon <br />nplice from the City and to replace public property <br />- ' �: � �� <br />Telephone Number � <br />- �� <br />Date <br />Fee , <br />Dept. Approvals <br />Communications <br />Approved by <br />Date Approvecl <br />