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I <br />CITY ENGINEERS <br />EVERETT, WA^HINGTON <br />The Undersigned <br />Hereby applies for permission to <br />At the following location <br />(Work to be done) <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />DRIVEWAY SECTION <br />NO SCALE <br />I I" LIP <br />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 & Gutter <br />Sidewalk <br />Inor'sSigneture <br />C� A/0 V % 9 <br />Onto <br />Remarks <br />11129 <br />e TM <br />t: : r.) . : i 1 :. -.- <br />11129 <br />PERMIT NO.-_ <br />The undersigned owner hereby tgrees to hold and <br />save harmless the City of Everett from any and all <br />claims for damages that may arise because of installs <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 />Address - - -_ <br />Telephone Number --- <br />Date <br />Fee <br />Dept. Approvals <br />Engineers__ <br />Water___ <br />Street_ <br />Communications__ _ <br />Traffic- <br />Planning - <br />Approved by <br />COPY Date Approved <br />