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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />cYerell <br />CITY FNGINEERS <br />EVERETT, WASHINGTON <br />The Undersigned A I f" r <br />Hereby applies for permission to t tr 0 <br />At the following location_17 <br />(Work to be done) <br />DRIVEWAY SECTION <br />NO SCALE__ <br />3Q-�+ <br />�n I 11" LIP II/ I� <br />-------�T'�� <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT.259 8811 <br />10921� <br />PERMIT NO)J <br />".." _ /fT i,4. 04t"�> <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 />damaged thereby. <br />Signature of Applicant <br />Address <br />Telephone Number <br />Date <br />24 HOURS BEFORE CONSTRUCTION] <br />CHECK LIST <br />— <br />Fee <br />Water Valve <br />Dept. Approvals <br />Drainage <br />Curb aGutter / <br />Sidewalk n6 <br />�,j� / <br />�T�� <br />Engineers_ -- <br />Water --- <br />Street <br />Communications -- <br />Inspector's Signature <br />Traffic— <br />Planning — <br />Date <br />Remarks <br />Note: Original to Cr.1- mer <br />1 Copy to F .le 10921 <br />_ <br />Approved by <br />1 Copy to Inspector <br />Date Approved <br />