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11 <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />The Undersigned r- - M ;LA - <br />Hereby applies for permission to e'b ni c .,c.., <br />At the following <br />SKETCH <br />(Work to be done) <br />1 <br />DRIVEWAY SECTION <br />NO SCALE <br />*I" LIP <br />I.301, <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 />a"14(}(' <br />w „/ <br />Q �r I'� <br />Drainage <br />Curb &Gutter <br />Sidewalk <br />Inspector's Signature <br />Remarks <br />Note: Original to Customer n p <br />1 Copy to File j 0 g j J <br />1 Copy to Inspector <br />10939 <br />PERMITN . <br />0 <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 upon <br />notice from the City and to replace public property <br />damaged thereby. <br />Signatdre of Applicant <br />� r r <br />Telephone Number <br />Date <br />Fee <br />Dept. Approvals <br />Engineers ,1,4[ <br />Communications <br />Traffic <br />Planning <br />Apgqfroved y ������ /a <br />Date Approved 'yj �!% <br />