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evcren <br />CITY ENGINEERS <br />EVERET T, WASHIIJGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />The Undersigned VdILAe <br />1075E <br />PERMIT NO._ / "L'1 <br />Hereby applies for permission to '0415 .:TyG> 14 <br />At the following location �� i •Z `7 S/%%, C <br />(Work to be done) <br />DRIVEWAY SECTION <br />The undersigned owner hereby agrees to hold and <br />NO SCALE <br />I "I <br />save harmless the City of Everett from any and all <br />claims for da)nages that may arise because of installa• <br />1I" LIP <br />tion and maibtenance of the impro4ement hereto <br />-----------�f� <br />applied for aKid further agrees to remove sWe upoA <br />notice from the Cjfii, and to replace public property <br />damaged (hereby: <br />y r ! <br />Signature of App i <br />I <br />OPY OF THIS APPLICATION TO <br />Address <br />E POSTED ON JOBSITE.ALL <br />ENGINEERING DEPT. 259-8811 <br />[24 <br />Telephone Number <br />TOURS BEFORE CONSTRUCTION <br />Date <br />�, U 7 <br />CHECK LIST <br />Fee / (�, ' � <br />Water Valve <br />Drainage <br />Dept. Approvals <br />Engin✓ <br />Sidewalk <br />Water 40— <br />49i <br />Street <br />— <br />Communications <br />Traffic <br />Planning — <br />ate <br />10, <br />Remarks <br />Note: Original to Customer <br />1Copy toFile 10756 <br />1 Copy to Inspector <br />Approved by <br />Date Approved <br />