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APPLICATION FOR n;-UHT-VY-PVAY USE PFRivii7 <br />W <br />11003 <br />CITY ENGINEERS <br />EVERETT, WASHINGTON PERMIT NO. I <br />The Undersigned <br />Hereby applies fc <br />r___LLS <br />At the following location ' Q A2 4- T77�—�aZ ^ 5 j_0=- <br />SKETCH <br />(Work to be done) <br />d, <br />DRIVEWAY SECTION <br />NO SCALE <br />ILIP <br />COPY OF THIS APPLICATION 1"0 1 <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 259"11811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb &Gutter <br />Sidewalk <br />Inspector's Signature <br />Remarks <br />Note* Original to Customer <br />1 Copy to File 11 n n 3 <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 twcause 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 />Signature of Applicant <br />Telephone Numbero"- <br />Date <br />Fee <br />Dept. Approvals <br />Engineers _ <br />Water_ <br />Street__ <br />Communications <br />Traffic_ _ <br />Planning <br />Approved by <br />Date Approved <br />