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- eVlrep <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />The Underrlgned <br />Hereby applies for permission to <br />API'LICATION FOR RIGHT-OF-WAY USE PERA111 <br />1i 0nl <br />At the follovdno location <br />r. <br />SKETCH <br />(Work to be done) <br />Set` A1TAeAit0P <br />A <br />la <br />DRIVEWAY SECTION <br />NO SCALE <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 259.OUI1 <br />24 HOURS BEFORE CONSTRUCTION <br />NECK LIST <br />Wanr Valve <br />Drainage <br />urb 1, Gutter <br />Sidewalk <br />Inspector's Signature <br />Remarks <br />Note: Original to Customer <br />I Copy to File 11001 <br />I Copy to Inspector <br />PERMIT NO.I_--..i I i <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 arito because of installs <br />Lion 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 />damp thereby. <br />� Glc.�---- <br />nn ur 1 Applicant <br />Addm%- <br />Tclepho umber <br />Date <br />Fee ,%(���� • <br />uept. Ap ova�� <br />L• // <br />Engineers <br />Water_._ <br />Communications <br />Traffic— <br />Planning — <br />Approved by <br />n,,. A.....•..,. <br />