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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />cvcrelt <br />® 10011 <br />CITY ENGINEERS <br />EVERETT, WASHINGTO�"� I 'I PERMIT NO. (p <br />The Undersigned r"t I L_ L_ 1 � 1411 ME S I N L <br />Hereby applies for permission to c oliy s ? G A. Z I A6 C A.W- b12 / L%&j,J ft <br />r� � <br />At the following location ( <br />(Wotk to be done) <br />DRIVEWAY SECTION <br />NO SCALE <br />I" LIP <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 259-8811 1 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />a — <br />te <br />� <br />Remarks "7�J �e,.14 <br />Note: Original to Customer 2 � <br />I Copy to File 10 0 �. <br />I Copy to Inspector <br />The undersigned owner hereby agrees to hold and <br />I' <br />save harmless the City of Everett from any and all <br />b t <br />claims for damages that may arise because of installa <br />I L) I f <br />tion and maintenance of the improvement hereto <br />L V <br />applied for and further agrees to remove same upon <br />notice from the City and to replace public property <br />damag? thereby <br />_ <br />i lure o pplican <br />Address <br />Telephone Number <br />%- <br />tint. <br />alo0 <br />Pcv o b-1 <br />by <br />Date Approved <br />