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everett <br /> APPLICATION FOR RIGHT-OF-NAY USE PERMIT <br /> 10090 <br /> CITY ENGINEERS <br /> EVERETT,WASHINGTON <br /> �"� PERMIT NO, 74-26?- <br /> The Undersigned A WALi7 -4421. 0M0 <br /> Hereby applies for permission to <br /> At the following location_ 76, <br /> SKETCH <br /> (Work to be If ne) <br /> So' Ek ISTAC7 c 0(Ur, ¢ y v <br /> beg I <br /> .i <br /> NE w ASPIOLT IN <br /> Lrr _ <br /> DRIVE 11YAV <br /> Ih 3i,5 <br /> .SLgg TEf <br /> I <br /> EDGE OF <br /> EXIST/NG PAVOVENT <br /> DRIVEWAY SECTION The undersigned owner hereby agrees to hold and <br /> NO SCALE save harmless the City of Everett from any and all <br /> claims for damages that may arise because of installa. <br /> I' LIP tion and maintenance of the improvement hereto <br /> 30„ I �[/y�}►- I applied for and further agrees to remove same upon <br /> -""�1630 notice from the City and to replace public property <br /> dar d there y. <br /> 4402 <br /> Signature of Applice <br /> --- 7 ' T S <br /> COPY OF THIS APPLICATION TO Ad res <br /> BE POSTED ON JOBSITE. 3 5'S' 7 2 `L _ <br /> CAI ENGINEERING DEPT, 2598811 Telephone Number <br /> 74 HOURS BEFORE CONSTRUCTIONPe ;D M-2_700atte <br /> CHECKLIST Fr <br /> ee S0 A /a 16 •74C <br /> Water Valve <br /> Drainage Dept. Approvals <br /> Curb&Gutter Engineers , Z-(oma 7 Y <br /> Sidewalk I <br /> Water <br /> Street <br /> "r�u Commurrcatio <br /> Inspector's Signature <br /> Traffic <br /> � Ilr _ 7 f11 Plannin ( <br /> r � <br /> — <br /> Remarks rd <br /> Note: Original to Customer �C/J <br /> 1 Copy to File 10090 r, <br /> 1 Copy to Inspector Approved <br /> Date ApprKed <br /> �L/CC. 7� <br /> i <br /> I <br />