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APPLICATIOf� FOR R!r.HT_nF-WAY USE PERMIT <br />evereYl <br />� <br />CITY ENGINF.ERS <br />EVERETT,WASHINGTON <br />The Un�iersigned _ <br />Here6y applies for permission to <br />At the following <br />SKETCH <br />(Work [o be done) <br />DRIVEWAY SECT!ON <br />NO SCALE <br />�----- ------ --"� <br />� I•� LIP I <br />�_ 30'� _ _ 30" I <br />i- .._-----_._ - —.. <br />COPY OF THIS APPLICP�fION TO <br />BE POSTED ON JOBSIT[. <br />CALL EN��INEERING DEPT. 259-8511 <br />'4 HOURS f3EFORE CONSTRUCTION <br />CHECIC LIST <br />Water Valve <br />Drainaae <br />Curb & Gutrer <br />Sidewalk <br />� : <br />PERMIT N0._ �� <br />Thc undersigned owner hereby agrees to hold znd <br />save harmless the City of Everett from any and all <br />claims for damages that may arise l;ecause of installa� <br />tion and maintenance of tl�e improYernen[ hereto <br />applird for and further anrees to remove same upon <br />notice from the City and to replace public property <br />damaged thereby. <br />Signature of Applicant <br />ress <br />Telephone IVumber <br />Fer. <br />Enai <br />/'C� Wa[e <br />� - ,/./c �� � L.. <br />Stree <br />�ti't `'� Com <br />c/( �//�;,��:1' Traf1 <br />� Plani <br />� r '� <br />_ -- c_' ,.i ,.. <br />Dept. Approvals <br />Approved by � - _ � -- �-- . <br />Date Approved <br />ii:;'F��-�.:-�_,_ _, - <br />3 <br />