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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />. '- a•zvera <br />CITY ENGINEERS <br />=.VERETT,WASHINGTON <br />• I o Undersigned _ <br />Nrlaby applies for per <br />rmission to <br />At the following location_ <br />SKETCH <br />(Work to be done) <br />10642 <br />PERMIT NO. <br />i <br />I <br />I <br />• <br />- <br />�•. <br />V <br />I <br />I <br />t <br />I <br />i � <br />I <br />DRIVEWAY SECTION <br />NO SCALE <br />—33 t - <br />I \ <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JORSITE. <br />CALL ENGINEERING DEPT. 259.8811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />AA <br />�J <br />Inspector's Signature <br />z <br />ate <br />Remarks <br />Note: Original to Customer <br />ICopy toFile 1.0642 <br />1 Copy to Inspector <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 Flstalla <br />lion and maintenance of the improvement hereto <br />applied for and further agrees to remove same upon <br />notice kom the City and to replace public property <br />damaAd thereby. — , <br />S' TTur,of Applicant O <br />a a nY is�93 uA"h �� J <br />Address <br />Telep ono Number <br />Fee <br />Dept. Approvals <br />Engineers ,_- <br />�� <br />wnrer i <br />Street��__ <br />Cnmmunicetions_ _ - <br />Traffic <br />Planning _ <br />Approved by <br />Date Approved <br />