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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> 10047 <br /> CITY ENGINEERS <br /> PERMIT NO. <br /> EVERETT,WASHINGTON Ra I ' <br /> The Undersigned 1 L VAI &u-r-> Q LY O ��,0 NJ <br /> Hereby applies for permission to C' O fJS't/Z �s Z5 r i�� 1 fJ f� �S PI-1 Q 121 u e lIJ A N <br /> S 1` <br /> I At the following location O Tf S 1'. <br /> -- <br /> SKETCH - <br /> (Work to be done) <br /> C G AuV 115 <br /> No SoB <br /> SCALL; ISI w S. Wn, �vrt � <br /> �B�ota.6d <br /> vtnn=R- LINE, ADJUST <br /> ME�2 E^x -Tra ra2Aoi, <br /> A5 R�41JI Rt�p, <br /> III <br /> DRIVEWAY SECTION The undersigned owner hereby agrees to hold and <br /> NO SCALE (( i save harmless the City of Everett from any and all <br /> `�ll claims for damages that may arise because of installa- <br /> tion and maintenance of the improvement hereto <br /> I' LIP_ applied for and further agrees to remove same upon <br /> notice from the City and to replace public propel ty <br /> -- ----- - 't' damaged thereby. # HI`_LtAJT CO. W IL5OA1 <br /> X C- ;Ct/ I C !+ <br /> Signature of Applicant <br /> / <br /> Address <br /> COPY OF THIS APPLICATION TO A dress <br /> BE POSTED ON JOBSITE. Telephone 35e Number <br /> S 3 O <br /> �/ <br /> CALL ENGINEERING DEPT. 2598811 -7 —7� 7 / ----�7� <br /> 24 HOURS BEFORE CONSTRUCTION Date / 2 6� y/ <br /> CHECKLIST Fee� ff 3(a <br /> Water Valve kers � Ute, Dept.�prove 9 <br /> Drainage ``11 <br /> W.4 37 <br /> Curb&Gutter <br /> Engineers <br /> Sidewalk ( Water <br /> J <br /> Street_ ' <br /> p g 1��•G.t�-- Communication - <br /> Inspect Si natu e ' /3 /f Traffic <br /> / Planning r <br /> ate <br /> Remarks <br /> Note: Original to Customer <br /> 1 Copy to File 10047 Approved by <br /> 1 Copy to Inspector <br /> Date Approved ����� <br />