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W <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />APPLICATION FOR RIGHT -OF WAY USE PERMIT <br />10804 <br />PERMITNO.__,'__._ <br />The Undersigned eyex 2 !' x i - <br />Hereby applies for permission to -' 1 (•�' /'%'• I ---_ <br />At the following location <br />(Work to be done) <br />NOT FOR CONSTRUrTnnv <br />DRIVEWAY SECTION <br />NO SCALE <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 2598811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST Apha <br />Water Valve <br />Drainage <br />Curb 6 Gutter Zvi ^ G <br />Sidewalk MIIKC <br />Inspe�ctyory's�Signature 0 <br />—ate -—got <br />—ate <br />Remarks <br />Note: Original to Customer <br />1 Copy to File 10804 <br />1 Copy to Inspecto <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 ilia improvement hereto <br />applied for and further agrees to remove some upon <br />notice from the City and to replace public property <br />damaQedtthereby. rT' <br />Signatura of Applicant ..,� <br />r <br />Telephone Number <br />Date <br />Fee <br />Dept. Approvals <br />Engineers . <br />Communications <br />Approved by <br />