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everen <br />e <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />The Undersigned J/HL L <br />Hereby applies for permission to <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />10971 <br />r' <br />PERMIT NO. <br />At the following location 31 —T <br />SKETCH <br />(Work to be done) <br />r <br />Jr- c <br />DRIVEWAY SECTION <br />NO SCALE <br />f I" LIP—7�1I <br />COPY OF THIS APPLICATION TO <br />BE ?OSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 258 8811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />Note: Oi iginal to Customer <br />I Cop;' to File 'j 0 Q 7 1 <br />i Copy to Inspector <br />r <br />/}7 1 ri(: ff O <br />The undersigned owner hereby agrees to hold end <br />save harmless the City of Everett from any and all <br />claims for dame s that may arise because of installa- <br />tion and maint ance of the improveplent her <br />noticed for an . ui)r agrees to rerp c <br />notice from a Ci) rtd to repl p lic <br />damaged t i/✓// <br />rsaarass <br />t1LAI <br />Telephone Number <br />Fee <br />Water <br />Street <br />Communications <br />Approved by <br />Date Approved <br />