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ki <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />Thc Undersigned ,4/s_rip <br />Hereby applies for permission to <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />At the following location -- R, .S%/ _S E. <br />SKETCH <br />(Work to be done) <br />IZ' <br />Nth/ ASPHALT <br />2118 <br />EDBE 13F EX2TIUG <br />PAVEMENT <br />DRIVEWAY SECTION <br />NO SCALE <br />I" LIP <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 2598811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage ' <br />Curb & Gutter <br />Sidewalk <br />Inspector'l Signature <br />Remarks <br />Note: Original to Customer <br />1 Copy to File 10093 <br />1 Copy to Inspector <br />ren u P <br />I-= <br />U7 <br />Z <br />Oke <br />LW <br />—10093 <br />PERMIT NO. 7 r —209 <br />74TH 3 7- -5 <br />NO SCALE <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 />a �,4S <br />Signature o pplicant grrNy Boe Mw,tn <br />&I., 4 "R u e <br />Address <br />Telephone Num r -- <br />�e a �y Data is o cl <br />Fee �! �l Dept. Approvals <br />Approved by <br />OL <br />Date oved <br />X-I <br />