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rdi <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />The Undersigned _ 1 ) tie, <br />Hereby applies for permission to <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />At the following location 31 7 it e n S fi S V'/ <br />(Work to be done) <br />DRIVEWAY SECTION <br />{.� NO SCALE <br />I 1" LIP_ <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 259 8811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />Note: Original to Customer 1 Copy to File 7-I.rn <br />71 4 <br />1 Copy to Inspector <br />10714 <br />PERMIT NO. 7 7 " Z2_ <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 Installs - <br />Lion and maintenance of the improvement hereto <br />applied for and further agrees to remove some upon <br />noti the end t apiece public property <br />age th <br />S' ture of Applicant Azti <br />AdAd re — _ RIO,!-0 �f1Y~03 <br />Telephone Nurr.bqLh _ _, <br />Date a <br />Fee <br />Dept. Approvals <br />/7 <br />Engineers <br />Water � �' � ✓, <br />Stre <br />Communications <br />Planning_�—G�-` `.- <br />Approved by <br />Date Approved <br />