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everett <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />DOA e <br />CITY ENGINEERS -74 _` 8 <br />EVERETT, WASHINGTO�' I ,��1f PERM IT NO. Z <br />The Undersigned 77 1 Lnt � T� b" "r S ' N c; <br />Hereby applies for permission to _"V1 S-T R <br />At the following <br />SKETCH -- <br />(Work to be done) <br />E:yLIST C09 GUT LOT ► D <br />�l <br />DRIVEWAY SECTION <br />NO SCALE <br />I \ 1 LILIP <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JORSITE. <br />CALL ENGINEERING DEPT. 2598811 <br />24 HOURS BEFORE CONSTRUCTION <br />I <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />ntq tor's Signature <br />No <br />SCALE <br />9►s-s- per, s.c. <br />Tha underigned owner hereby agrees to hold and <br />save harmluss the City of Everett from any and all <br />claims for damages that may arise because of installa. <br />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 property <br />RAID Dept. Approvals Ity//3J6 30 <br />Enninpprs'� <br />l. 7if nnnnniY ek. i <br />Iva <br />ate <br />Remarks x'vv .0el1(/� Vim/ <br />Note: Original to Customer (Qr/(%�/--" <br />1 Copy to <br />1 Copy to Inspector /�/r ved by <br />�-- <br />Date Approved <br />f' I <br />