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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> t•orn•It <br /> CITY ENGINEERS Y V I D <br /> EVERETT,WASHINGTON PERMIT NO. <br /> The Unde,signed lJ road wa4 rrr <br /> Hereby applies for permission to — (e O <br /> At the following location / 4 O 4 BOT•f1 S t-. <br /> SKETCH <br /> (Work to be done) <br /> MN to <br /> I <br /> 0 <br /> i <br /> I <br /> Asphn)t Povin9 I <br /> I <br /> I <br /> I <br /> Need Vnrtgrice -fan3 <br /> 1401 <br /> over legnl °/w ; III <br /> \Nrdth . <br /> a <br /> • � I r <br /> P/LPA <br /> { <br /> I <br /> i- 1 I <br /> DRIVEWAY SECTION The undersigned owner hereby agrees :o hold and <br /> NO SCALE save harmless the City of Everett from any and all <br /> claims for damages that may arise because of installs. <br /> i I LIP tion and maintenance of the improvement hereto <br /> �e /]/7L applied for and further agrees to remove some upon <br /> notice from the City and to replace pu is property <br /> damagby� <br /> _— ignetuu Aic <br /> COPY OF THIS APPLICATION TO Address <br /> BE POSTED ON JOBSITE. ��,..«� <br /> CALL ENGINEERING DEPT.2598811 Telephor <br /> 24 HOURS BEFORE CONSTRUCTION Date <br /> CHECK LIST Fee <br /> Water Valve <br /> Drainage 4 Dept. Approvals <br /> Curb&Gutter t I�/ Engineers <br /> Water <br /> Street <br /> Communications_ <br /> Inspector's Signature <br /> _ <br /> Traffic <br /> Planning <br /> Date S ,L-kL1 40e6C <br /> Remarks <br /> Note: Original to Customer <br /> 1Copy to File <br /> 1 Copy to Inspector Approved by <br /> Date Approved <br />