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0 <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />10071 <br />PERMIT NO. 74 — 183 <br />The Undersigned 9IL—L I S 1-16ME5 <br />Hereby applies for permission to �p/VS T"RUCT 25' CONCRETE OR / I/MINA Y <br />At the following location_ 7 10 — 9 I :7 T' PL . S E. <br />(Work to be done) <br />0 <br />NO SCOLE <br />DRIVEWAY SECTION <br />NO SCALE <br />I'----- 25� -~I <br />I" LIP <br />I I <br />I►`—•---..._—.lam—�I"�"y1 <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 259 8811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />.�,peZ��,ia <br />Insctor s Signature <br />ate <br />SUTTEe <br />CONCRETE <br />E WAY <br />The undersigned owner hereby agrees to hold and <br />save harmless the City at Everett from any and all <br />claims for damages that may arise because of installa. <br />Q '( 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 preperty <br />damm °rad thh�eyrttry <br />Signature of Applicant <br />Address G <br />355 _ y z <br />Telephone Number <br />DwA Date <br />� 012. <br />S�1 <br />Fee <br />Dept. Approvals <br />Remarks — <br />Note: Original to Customer '-- --- — — <br />1 Copy to File 10071 <br />1 Copy to Inspector Approved <br />date roved <br />i7)r <br />