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W <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />The Undersigned <br />HereLy appliesfo <br />fW(: 1, to be done) <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />DRIVEWAY SECTION <br />NO SCALE <br />/. LIP <br />COPY nF THIS APPLICATION TO <br />i BE POSTED ON JOBSITE. <br />CAI L ENGINEERING DEPT. 259 8811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />flrainage <br />�'urb & Guttxr <br />,idawalk <br />Inspector's Signature <br />-cite <br />Remarks <br />Note: Original to Customer <br />1 Copy to File 11001 <br />1 Copy to Inspector <br />11001 <br />PERMITNO. I !':�j <br />Sc'S /,?77-4eh�R <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 o' istalle- <br />tlon and maintenance of the Improvement hvreto <br />applied for and further agrees to remove same upon <br />notice from the City and to replace public property <br />damail thereby. <br />SilhatureoOf Applicant <br />Add <br />r <br />eleptonumber <br />Date <br />Fee �� ✓� �A( <br />Dept. App ovals, <br />C <br />5ngineers c ti <br />Planning <br />Approved by <br />Date Apprm:d <br />