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APPLICATION FOR RIGHT OF WAY USE PERMIT <br />PVPrrtl <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />10793 <br />PERMITNO. <br />The Undersigned DAL & t4 s 1�7L. SDrJ 7 <br />Hereby applies for permission to rd 1Ll. CT (j i s 6,`". V'/ <br />At the following location '730V <br />SKETCH <br />(Work to be done) <br />DRIVEWAY SECTION <br />The undersigned owner hereby agrees to hold and <br />NO SCALE <br />I <br />save harmless the City of Everett from any and all <br />—' <br />------� <br />claims for damages that may arise because of installa• li <br />I" LIP <br />tion and maintenance)of the improvement hereto <br />1I30' <br />applied for and further agrees to remove same upon <br />---------�1'� <br />notice from the City and to replace public <br />tY P P P party <br />dame thereby <br />ignaWre of Applica'— <br />__ <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />, <br />Address y-f.t- n <br />3" <br />CALL ENGINEERING DEPT. <br />259-881 I <br />Tele4ph�n� um ? <br />24 HOURS BEFORE CONSTRUCTION <br />IIi� <br />— <br />Date <br />a( <br />CHECK LIST <br />Valve <br />�^ r <br />" <br />Fee <br />Water <br />Drainage <br />r1 <br />Dept. Appravgla <br />Curb &Gutter <br />+���'' <br />Cd�t \ <br />Engineers <br />Sidewalk <br />Water ZZ <br />Street /`. %�_ '/ _I/ y / <br />Communications <br />Inspector's Signature <br />Traffic___ _ <br />Planning __ <br />Remarks <br />Note: Original to Customer <br />-- <br />I Copy to File <br />10793 <br />- <br />1 Copy to Inspector <br />Approved by <br />Date Approved <br />