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ki <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />The Undersigned Dr <br />Hereby applies for permission to <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />4- <br />At the following locations I f(i se IP/ S E _-- <br />SKETCH <br />(Work to be done) <br />.e add <br />Va <br />carer <br />e nL'4 <br />DRIVEWAY SECTION <br />NO SCALE <br />� 33pp �I 1•' LIP I p <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 />r <br />Inspec to Slgna ure <br />..3-/7-7i <br />10621 <br />PERMIT NO. 7Z - ?A 7 <br />fK CLY Lhut (�� <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 upoi, <br />notice from the City and to replace public property <br />damaged thereby. <br />Signature of pp cant <br />Address <br />Telephone Number <br />Date <br />'0 yo <br />Fee�� /Z Dept A y��'jI <br />Cl <br />/J <br />Engineers � <br />Water V s Ocsz <br />Street <br />Communications <br />Traffic ---"�t�--- <br />Planning ��'� �0 -1 4: <br />kLiCdw tu1z�y . <br />Note: Original to Customer <br />1 Copy to File 0 �` 21 <br />1 Copy to Inspector Appr •e y <br />Date ADD 011d �'41 f'/ <br />