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es erctt <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />The Undersigned <br />Hereby applies for permission to <br />10401 <br />PERMIT NO <br />At the following location :%4 <br />(Work to be done) 7 <br />5 "or/ <br />- H ZO ' AS/aygG 7- X:;kA vtiA16N1' <br />-- <br />DRIVEWAY SECTION <br />NO SCALE <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE, <br />CALL ENGINEERING DEPT. 259 8811 <br />24 HOURS BEFORE CONSTRUCTION <br />i <br />8[e <br />Remarks <br />Note: Original to Customer 1 Copy to File 10401 <br />1 Copy to Inspector <br />ZeI c <br />I <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 />y1applied for and further agrees to remove same upon <br />1 It notice from to Ci replace iblic property <br />d� ereby, s <br />Si at re o licant <br />1 'A <br />4 i.. Address 0 4' f0y/120// V ilCsyALk fbfh s . <br />Telephone Number q s 68 <br />3s}� G37.7 <br />Date <br />Z, <br />Fee <br />Dep ir Val <br />Engineers <br />A <br />d <br />Water <br />L. <br />Street <br />465 f Communications -- <br />Traffic <br />Planning / A, <br />S� a r` C r j <br />Approved by 3 <br />Date App oved <br />