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evcrett <br />�e <br />CITY ENGINEERS <br />EVERETT,�VASHINGTON <br />The Undersigned � � - <br />Hereby applies for permission to _ <br />At the (ollowing <br />(Work to be done) <br />APPLICATION FOR RIGFIT-OF-WAY USE PERMIT —/ p <br />� U � I O <br />N, ;r <br />DRIVEWAY SECTION <br />NO SCALE <br />r - - - -, <br />� �1'� LIP / <br />4„30'.�_' _ --.—____�30 I <br />'1 <br />' �COFY OF THIS APPLICATION TO i� <br />, BE POSTED ON JOBS�TE. ' <br />CALL ENGINEERING DEPT. 259�(iti17 <br />24 I�OURS BEf-OR[COPIST�U�'ll�l'�' <br />. CHECK LIST <br />Water Valve <br />Drainage <br />Cur6 & Gutter <br />Sidewalk <br />Inspeclor's Signature <br />�te <br />Remarks <br />Note: Original to G�smmcr 1 <br />1 Copy to Pile ' j�'� �� <br />1 Copy to Inspector <br />PERNITNO._ �' <br />� `. � — � /, �— <br />r <br />The undersigned owner hereby agiees to hold and <br />save harmless the City of Everntt from any and all <br />claims for damages that may arise because ot installa� <br />tion and main[enance o( the improvement hereto <br />applied for and further agrees to remove same upon <br />notice from {he City and to replace public properry <br />damaged theiehy. " <br />, � <br />Signalure ot Appiicant . i: ! <br />i <br />Address <br />Telephone Number <br />Date <br />� _ <br />Fee � <br />Dept. Approvals <br />Engincers___—.���_ �_.--= <br />Water <br />Commun <br />Planning_ <br />Approvc.. Uy <br />Datc Ap�noved <br />