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ki <br />CITY ENGINEERS <br />EVERETT. WASHINGTON <br />The Undersigned <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />10052 <br />PERMIT N0. /�4% 7 <br />Hereby applies for permission to UJIC L-OtJC. iiezil[-1�A4 <br />At the following location__ 4 i �' <br />(Work to be done) <br />MR <br />DRIVEWAY SE <br />NO SCALE <br />ri -- 2 !; f --- - ---- <br />I 11" LIP I <br />COPY OF THIS APPLICA110N 10 I <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 2598311 <br />24 1100R5 REFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspect ignat <br />�Zoe - <br />Note: Original to Customer rr1�s <br />1 Copy to File 1_t1052 <br />1 Copy to Inspector <br />L o T 2-2- <br />`3, <br />-3 7r <br />✓� Z� <br />12Cc1 0 <br />zi W � C-uen <br />No <br />5CALX <br />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 installs. <br />Lion 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 />T`- <br />Signatu—re of— <br />App Icon-f'— (t`�"--�— <br />Address <br />Telehone Niumeet , <br />Date <br />Fee t - <br />0 CC , Dept. Approvals <br />-ls--7t i „�/1�c141r'iy <br />Engin araI <br />Water _ <br />Street:. <br />Tc catio s <br />Traffiralfir, or. <br />Planning <br />Approved by <br />Date pproved <br />