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everett <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />.Lt1921 <br />PERMIT NO.-1,7' -2- �- <br />The Undersigned WAYY nX IlJr li4 <br />Hereby applies for permission to jHer.4t � 52rt 12-f TitE Fo.2 <br />At the following location—11e. -?5/7_1' -;r <br />SKETCH <br />(Work to be done) <br />O� fo Go�s7td� <br />DRIVEWAY SECTION <br />NO SCALE <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 289 8811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water V:Ive <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />Remarks <br />Note: Original to Customer <br />1 Copy to File 10921 <br />1 Copy to Inspector <br />SEd H'7Tr1 CAI ee> <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 be-,ause 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 />aged thereby. <br />V- <br />ignature of Applicant <br />J3/d 24z-zC -U- <br />Address <br />Telephone Number <br />Date. <br />Engineers_ <br />Water_ <br />Communlcai <br />Approved by <br />Daln Approved <br />Dept. Approvals <br />