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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />10948 <br />CITY ENGINEERS <br />PERMIT NO. 4 u• <br />EVERETT, WASHINGTON <br />The Undersigned <br />Hereby applies for permission to t•'�l� `/ + '• / <br />-- '` ' ' ° °/�� <br />At the following location <br />I <br />SKETCH <br />(Work to be done) <br />tl <br />1, <br />I <br />i <br />Ili <br />DRIVEWAY SECTION <br />The undersigned owner hereby agrees to hold and <br />NO SCALE <br />save harmless the City of Everett from any and all <br />claims for damages that may arise because of installa. <br />--� <br />tion and maintenance of the improvement hereto <br />f I" LIP <br />applied for and further agrees to remove some unon <br />I PQ4' }._30 <br />1' <br />notice from the City and to replace public property <br />dame d thereby., <br />rrr <br />Signaturer,of Applicant <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />Address <br />1111, <br />Telephone umb_e_r <br />CALL ENGINEERING DEPT. 25B-BB11 <br />¢; -/(r ] 7 <br />24 HOURS BEFORE CONSTRUCTION <br />Date <br />CHECK LIST <br />�L �y <br />Fee , <br />Dept. Approvals <br />Water Valve <br />Drainage <br />/1 <br />Curb &Gutter <br />Engineers iSidewalk <br />Water <br />Water <br />Communications <br />Inspector's Signature Traffic <br />Die — <br />Remarks <br />Note: Original to Customer !1 <br />I Copy to File 10948 c� J 4 <br />1 Copy to Inspector Approved by <br />Date Approved <br />