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W <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE f ER,MIT <br />10053 <br />PERMITNO_x —iar <br />The Undersigned _ H I L_ L.1 S <br />Hereby applies for permission to�6.Tr2 <br />At the following location_-7 S r E <br />(Work to be done) <br />kX157, If/w � cues <br />DRIVEWAY SECTION <br />NO SCALE <br />f- - --- 223 - -� <br />1I" LIP <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 2598811 <br />24 HOURS 1717PORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb &Gutter <br />Sidewalk <br />Lo T g <br />-713 <br />El <br />9I '�X PL, 5.P- <br />40, <br />Insp i s Sign <br />Wate��f% a <br />"--- <br />Remarks <br />Note: Original to Customer <br />1 Copy to File 10 0 5 3 <br />1 Copy to Inspector <br />Eall, V- <br />00 <br />5c" <br />l►e' <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 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 />damaged thereby. <br />Signature of A phcant --- <br />Address <br />Telephone Number <br />Date <br />Fnn <br />Approved by <br />Date Appr ed <br />y/27174 <br />