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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />evcrctt a i '- <br />. 0�177�0 <br />CITY ENGINEERS /J —�2 <br />EV E R E TT, WASH I N GTON PERMIT NO. Cl/ <br />The Undersigned JQii'N Gf1FFiVE Y <br />Hereby applies for permission to 008YEP//C T 2 - ZS' CaNC�2F_TE <br />Okll vE /1,/1-1 YS -- <br />At the following location <br />(Work to he done) <br />9 A <br />1 foD7 <br />DRIVEWAY SECTION <br />NO SCALE <br />r-2-25 <br />al" LIP <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEP1. 2598811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb $ Gutter <br />Sidewalk <br />Inspector's Signature <br />ale <br />Remarks <br />Note: Original to Customer <br />1 Copy to File 10170 <br />1 Copy to Inspector <br />NEW CONG2ETE <br />DRIVEWAY-5- <br />/ 0 0 9 <br />EX-EOFEXI <br />P4VOIWENT <br />A16 .5C/-iL E <br />4T:-1 <br />Zn' <br />/5' <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 />d aged t�lereb)". <br />S lure. of Applicant <br />/,S 0 L [°u �li L/ <br />Address <br />�v+1•-]Y , wa5� <br />Telephone Number <br />Date e< U <br />Fee <br />Appr24Nd <br />Date Appro ed <br />Dept. Approvals <br />