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ki <br />CITY ENGINEERS <br />EVEHETT, WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />WI. <br />PERIVIT NO.2" ;2 3 <br />The Undersigned _ jro n J <br />Hereby applies for permission to=nnc�,r.� <br />At the following location _ ' 2- 0 Cz <br />(Work to be done) <br />k. <br />DRIVEWAY SECTION <br />NO SCALE_ <br />��---/ 1" LIP�I <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBS[TE. <br />CALL ENGINEERING DEPT. 2598811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb &Gutter <br />Sidewalk <br />nspectT or's Signature <br />oete 516 -7 7 <br />Remarks <br />Note: Original to Customer <br />I Copy to File i n 6 2 8 <br />I 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 installs <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 />damago4hereby. ^ j � ' <br />Wgnalure of Applier/ <br />Address (/ <br />Telephone r4UMDOr <br />Fee f, <br />Dap App ovals <br />Engineers- s7r / s <br />Water�t <br />Street•., <br />Communications;:__ ,i ✓-_ / ,.�, ,. <br />Traffic <br />Plapning �— ' <br />Approved bs! ' I / -- <br />Date Appr vb ed <br />