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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />everett <br />10924 , <br />CITY ENGINEERS / <br />EVERETT, WASHINGTON PERMIT N <br />The Undersigned I., /,,:.-1 t . a L � , I , a r: / <br />Hereby applies for permission to , , , - r T I �� : .4, /iG, l r. i— <br />At the following location i 7i , - �� •,/,/, <br />SKETCH <br />(Work to be done) <br />DRIVEWAY SECTION <br />NO SCALE <br />I" LIP <br />9 ___ 30" <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 Ili Gutter <br />Sidewalk <br />Inspector's Signature <br />mate <br />Remarks <br />Note: Original to Customer <br />1 Copy to File <br />1 Copy to Inspector <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from ar,y 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 the City and to replace public property <br />damaged thereby. �^ <br />1_ <br />Signatu.re of pp icant _. <br />1 <br />Address <br />,�-, -, `.', /V 1 <br />Telephone Number <br />Date �y <br />Fee <br />Dept. Approvals <br />Engineers <br />Water <br />Street <br />Communications _ <br />Traffic <br />Planning_ <br />Appr ad b./L �•G� :' <br />Date Approved.77 <br />