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e VNR'll <br />i <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />The Undersigned J ov i <br />Hereby applies for permission to <br />At the following <br />(Work to be done) <br />DRIVEWAY SECTION <br />NO SCALE <br />rI <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />COPY OF THIS APPLICATION TO <br />BF. POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT.259.8811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb ff Gutter <br />Sidewalk <br />Inspector's Signature <br />Vale <br />Remarks <br />Note: Original to Customer 1.09719 <br />1 Copy to File <br />1 Copy to Inspector <br />10939 <br />PERMIT NO. T 7— <br />S EE A-17,pC NEJ <br />e�� 4, �/ v <br />�S <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 there <br />Sigrtat'fsre of Applicant <br />�.�5r'- _EvCrGt/ wa <br />Address <br />3T5 -9ii 4 _ <br />Telephone Number <br />F,-/a-11 <br />Date <br />Fee <br />Dept. Approvals <br />Engineers <br />Street <br />Communications__ <br />Traffic <br />Planning__ <br />Approved by <br />Date Approved <br />