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I <br />i <br />_ <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />10620 <br />PERMIT NO. 14 - 2,7 L <br />The Undersigned Dt P n /- a d 1, i (< yn n (im t t) <br />Hereby applies for permission to 25' /i <br />At the following location S(/ : c P/ SE 7 <br />SKETCH <br />(Work to be done) <br />—VJ <br />V <br />DRIVEWAY SECTION <br />NO SCALE <br />1" LIP <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT.269 8811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />-fr(spector s Si naturd — <br />Remarks � r <br />Note: Origii ml to Customer <br />1 Copy to File <br />1 Copy to Inspector <br />A <br />� 0 <br />0 <br />�1. <br />I I <br />U11q tar ri awt 0(4, <br />Mete/ <br />Note: Sr <br />Va /v C <br />LOLot <br />Lot <br />wl�e ShvtP(f <br />Shop/d bj��f�tPd <br />1?4L <br />l one f 1a/^s,00 <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from sny 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 puulic property <br />damaged thereby. <br />Signature of App cant <br />Address <br />Telephone Number <br />..a.a n <br />Fee, ./ i1'� <br />Dept. Appr6vfa <br />Engineers Z :7.4 <br />WateIJA 1 11 <br />1WA—x <br />Street 41;-1. �44 <br />Communications <br />Traffic / <br />Planning <br />10620 APPr+>,' <br />Date Appr6ed <br />