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WAPPLICATION FOR RIGHT-OF•WAY USE PERMIT <br />CITY ENGINEERS PERMIT NO <br />EVERETT.WASHINGTON <br />The Undersigned 14ILLIS HDIVES INC. <br />Hereby applies for permission to 23' CONCRETE D/IA! <br />At the following location 80 (a — 9 (ST PL. S. E . <br />(Work to be done) <br />10070 <br />74_18z <br />I <br />EXISTING 25 <br />�� $S CURB AND <br />SIDEWALK <br />NEW CONCRETE <br />DRI I/LWRY <br />24 <br />i <br />f3G6) \ <br />I <br />NO ZI71F, <br />22 <br />DRIVEWAY SECTION <br />NO ,SzCALE <br />I" LIP <br />COPY OF THIS APPLICATION TO <br />BE P)STED ON JOBSITE. <br />CALL ENGINEERING DEPT. 259 8811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb 11 Gutter <br />Sidewalk <br />Inspector's Signature <br />�L <br />� e�z— 1 <br />Remarks <br />Note: Original to Customer <br />1 Copy to File 10070 <br />1 Copy to Inspector <br />2,3 <br />� VD <br />., 7 — -71 <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 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 />demagpa thp Ay. <br />Signature of Applicant <br />Address <br />¢3-061-3 <br />Telephone Number <br />/Ij-/%-%sf <br />Date <br />// so -660� <br />Fee <br />Dept. Approvals <br />Approved— <br />�sy <br />Date Approved <br />QGi. G' i <br />7y <br />7r <br />