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APPLICATION [OR RIGHT-OF-WAY USE PERMIT <br />1081.0 <br />� � v <br />CITY ENGINEERS <br />EVERETT, WASHINGTON PERMIT NO_ — <br />The Undersigned f , . �t I ,- <br />- <br />HerebyappliesforpennissiontoAt the following location - — -- ----- <br />(Work to be done) <br />DRIVEWAY SECTION <br />The undersigned owner hereby ,,grees to hold a,d <br />NO SCALE <br />sava harmless the City of Everett from any and all <br />L------- -----� <br />claims for damages that may arise because of Installs <br />lion and maintenance of the improvement hereto <br />I" LIP <br />applied for and further agrees to remove same upon <br />notice from the City and to replace public property <br />damaged thereby. <br />Signature of Applicant <br />COPY OF THIS APPLICATION TO <br />Add,ess <br />BE POSTED ON JOBSITE. <br />TJaphone Number <br />CALL. ENGINEERING DEPT. 259 8811 <br />24 HOURS BEFORE CONSTRUCTION <br />Date <br />CHECK LIST <br />Fee <br />Water Valve <br />Dept. Approvals <br />Drainage <br />Curb & Gutter �� <br />�,17� <br />Engineers _ <br />Sidewalk �d /%en12r.., <br />Water --- <br />Street <br />Communications <br />Inspector's Signature <br />Planning _—_. <br />— ate <br />Remarks <br />Note: Original to Customer 1 Copy to File 10810 <br />1 Copy to Inspector <br />Approved Dv <br />Date Approved <br />