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ki <br />CITY ENGINEEPS <br />EVERETT.WASHINGTON <br />APPLIrATION FOR RIGHT-OF-WAY USE PERMIT <br />The Undersigned Zth ,Js HI'1 L Or-/rRi <br />Hereby applies for permission toZ('N57�Zs1[ T-�� 2t7 <br />At the following location s?D °f <br />(Work to be done) <br />- DRIVEWAY SECTION <br />NO SCALE <br />LIP <br />7- <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT.259 BB11 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb &Gutter �-^/ <br />Sidewalk �tj"� <br />No r <br />Inspector's Signature <br />Note: Original to Customer /�(� <br />1 Copy to File 19719 <br />9 f-/ 19 <br />1 Copy to Inspector <br />10719 <br />PERMIT NO.-��Z <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Fve.rett 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 some upon <br />notice from th City and to replace public property <br />daplaged they. /' 7- _ 7, <br />Aaaress <br />Telephone Number ty, 5-7 <br />L i <br />- 7 3-77 <br />Date � <br />l��� /D DuE ,z <br />Fee <br />Dept. Approvals <br />Engineers <br />ly <br />Water <br />i <br />Communications <br />Traffic__ <br />Planring_. <br />Approved by <br />Date Approved <br />