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everett <br />it 6 <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />The Undersigned <br />Hereby applies for permission to <br />At the following location <br />(Work to be done) <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT 11190 <br />DRIVEWAY SECTION, <br />NO SCALEi <br />I" LIP <br />3o' <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 259-8811 <br />24 HOURS BEFORE CONSTRUCTION <br />PERMIT No. Zr- / r! <br />1\1 <br />C x, a,-; 1 rv! h <br />l..._• � `-�._" I t-J "'I � i ^� a t: -r <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />t _ <br />Inspec r s1Si nature <br />7,( -7� <br />-Date <br />Remarks <br />11190 <br />INSPECTOR'S COPY <br />' � A <br />The undersigned owner 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 />1 A l <br />Signature of Apphcant <br />Address <br />Telephone Number <br />Date <br />Fee1j c` Jam: -: ; i 30J �.�� �. - /­ <br />d Dept. Approvals <br />Communications <br />Approved by { <br />Date Approved p9 <br />