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everett <br />� <br />CITY ENGINEERS <br />EVfRETT,WASHINGTON <br />APPLICATIO�I FOR RIGHT-OF-WAY USE PERMIT <br />11035 <br />PERMITNO. ��/.3�5� <br />The Undersigned AA//� � ii I-) r'•. i i=,_' <br />N.iebyappliesforpermissionto� o/�STI'��i t �.sZ� � �'�;i„�•�',S � Q��,� <br />At the following location_ S/ � t� sT c-7- <br />(VPork to ba done) <br />;r_"E �1 %%,1,N'D <br />DRIVEWAY SECTION <br />� Sr,ALE_—__ <br />� +I" Lir / I <br />I 3p" � <br />ti-__..�—__ _ �30" <br />COPY OF iH15 AFPLICi�TION TO �i <br />BE POST[D ON JOF3SITE. <br />CALL ENGINEERIMG DEPT. 259�8871 I <br />� 2-0 IIOURS 9EFC)RE CONSTRUCTIC�fdI <br />�— <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspec[ois Si9naturc <br />Remarks <br />Note: Original [o Customer (� <br />1 Copy to File �'11.i'� 5 <br />1 Copy to Inspector <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and al� <br />claims for damages that may arise because of installa- <br />:ion and mainten.��ce of the improvement ha;eto <br />applied fer ;:�d further agrees to remove same upon <br />notice f�om the Ciry and to replace public property <br />dam ere � / � <br />A�igna�tryure ef A p icant ' <br />f@Sf ��� � � <br />_��53 - 6 Soo <br />Telephone Number --- <br />/�S-/7- J % <br />Date <br />Fe H.�� � : — <br />r j� <br />Dept. Approvals <br />�� <br />Engineers__ � � �t',%,i� <br />5trc�[ <br />Cammi <br />''!annin�• <br />ApProved by <br />Date Approved <br />