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i <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />10870 <br />PERMIT NO._�_ <br />The Undersigned PA i j 4 _c C 4 C n 14 Jk — <br />Herebyappliesforpermissionto COt�e5r^ r ,a y �'n. - %�•� D/w <br />At the following location_3 J, 3 / %-" 'L <br />(Work to be done) <br />DRIVEWAY SECTION <br />_ NO SCALE <br />I" LIP <br />30" <br />COPY OF THIS APPLICATION TO <br />RE POSTED ON JORSITE. <br />CALL EivGINEEflING DEPT. 25g8R11 <br />')A Iil I Wi P.! I lMr '".f7NSTRUCTION1 <br />I CHECKLIST I <br />Water Valve II <br />Drainage <br />Curb &Gutter <br />Sidewalk <br />Inspector's Signature <br />Sc S iI"A;H1?,fq <br />'j e 11,!t i <br />Remarks <br />Note: Original to Customer o O <br />1 Copy to 1• ile 10870 <br />1 Copy to Inspector <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 me!gtenance of the Improvement hereto <br />applied for aftd further agrees tofemove same upon <br />notice from the Ci(y and to replace public property <br />damaged thereby. <br />Signature of Appfianf — <br />Address �.�• <br />Telephone Numb r <br />/ Date / <br />Dept. Apprnvals <br />Engineers e �P' (('(-✓" <br />Communications <br />Planning_ <br />Approved by <br />Date Approved <br />