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APPLICATION I- -OH HIGHT-OF-WAY USE PERMIT <br />10012 <br />.e <br />CITY ENGINEERS <br />EVERETT, WASHINGITION I PERMIT NO. �� /Z 7 <br />The Undersigned _ i 1 I► 1 S i' O M£ S iV C' <br />Hereby applies for permission to GO t✓ S T 12 /� 2 S r W I I>e CEO tJ L C t21 ALLIAy__ <br />At the following location % d 2— <br />(Work to be done) <br />DRIVEWAY SECTION <br />NO SCAL€ <br />I 3 11" LIP �I <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT.259-8811 <br />2 HHOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curt, & Gutter <br />Sidewalk <br />Ra .1 ' <br />Inspector' Signature <br />%— �d'—) Cl <br />Date <br />emarks <br />Note: Original to Customer 1 Copy to File 1 n 0 1 2 <br />1 Copy to Inspector <br />No <br />SCALE <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 />do d thereb <br />i lure dice <br />Address _ <br />Telephone Number <br />%— 9'— <br />Date <br />— I P <br />Fop <br />V <br />a �y Dept. Approvals '41.5 5.0° <br />Approved by <br />Date Approved <br />REA <br />