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q4t. <br />ki <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />The Undersigned m✓/"G� <br />Hereby applies for permission to <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />11006 <br />PERMIT NO. -77- --=3 (o5 <br />At the following location _P) lG T I 15�J- <br />16 0-1 Y <br />SKETCH <br />(Work to be done) <br />DRIVEWAY SECTION <br />NO SCALE ��11 <br />" LIP1-30 <br />/ II <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 2598811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECKLIST <br />Water Valve <br />Drainage <br />Curb a Gutter <br />Sidewalk <br />Inspector's Signature <br />Remarks <br />Note: Original to Customer <br />1 Copy to File 11 o n 6 <br />1 Copy to Inspector <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 />$i natur o pp scant <br />Addreps / <br />-ri e • H �% i✓ A . <br />Telephone INUffiber <br />e-2-�7- 0 Lo, <br />Tate <br />- i <br />Fee 1115, <br />�qxp�ipr <br />Engineers <br />Communications <br />Traffic <br />Planning <br />Appl oved by <br />Date Approved <br />