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evcren <br />� <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />lhe Undersi9ned <br />Hereby applies for permission to <br />At the following I <br />(Work [o be donel <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />. _. ._:i-.� <br />!Jo Si S/%� <br />DRIVEWA� SECTION <br />NO SCALE <br />r -- ~+ <br />I'� LIP <br />�30 �___. -�—_—. _--�j'3�1 <br />i <br />� COPY OP THIS APPLICATION TO . <br />BE POSTED ON J06SITE. , <br />� C;�.t.l_ f�dGlt,�F1-Rl'�7G DEPT.25931i� I <br />�7��li(Jl�i�:li�icl-(�lil i:QNSTRUCl'IUi{�. <br />CHECK LIST <br />Wate� Valve <br />Drainage <br />Curh & Gutter <br />Sidewalk <br />�'i . <br />� ; . <br />Inspector's Signatum <br />Note� Original to Customer 1^ ` n <br />1 Capy In Pilr. . i• r. ,. <br />1 Copy ta Inspectc <br />PERMITNO. .._�._� - <br />,. R <br />The undersigned owner hereby agrees m hold and <br />save harmless the Ciry ot Everett from any and all <br />claims for damagr,s that may arise because of installa� <br />tion and maintenance of the improvement here[o <br />applied for tnd further agrees to remove same upon <br />notice fro�n,the City and to replace public properry <br />damaged tlieicby. � , <br />Signature of Applicant. <br />. i <br />Address <br />Telephone Number <br />Dept. A�provals <br />Ccmmunications <br />Plann <br />Approved by <br />Da�c l�ppiovcd <br />N <br />