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kiAPPLICATION FOR RIGHT-OF-WAY USE PERMIT 10519 <br />CITY ENGINEERS PERMIT NO. 7& _ 14 Z <br />EVERETT,WASHINGTON C <br />The Undersigned f r' C✓ -_ � � J <br />Hereby applies for perrpL55i nn to - <br />�T C�/C'7.1 Z//3 1/l� , �7'i�Tf S-r <br />At the following <br />(Work to be done) <br />OL Pwr= <br />iZ / f �ri• L' C... �.t <br />'�TD1L <br />f1' <br />DRIVEWAY SECTION <br />NO SCALE -- <br />+I" LIP /J <br />i <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 />,2 �i✓o�'G,—u�r <br />Inspector's Signatures <br />� ate <br />Note: Original to Customer <br />1 Copy to File 10 51.0 <br />1 Copy to Inspector <br />PLL 1VC--P-WZ <br />To I7- NII,J <br />The undersigned owr r 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 />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 />damaged thereby. <br />Signature of App (cant , <br />/ 7 '74, ,. ,l i 41 <br />Address <br />Telephone Number ���•� ,� �,/ J^ <br />Da <br />A/ 0Af f <br />Fee <br />Dept. Approvals <br />Engineer4----- <br />Water i' i <br />J\ICCI -� <br />Communications ' • - <br />Planning <br />S _- ti• <br />Approved by <br />Date Approved -� / <br />