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011 <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PFRMIT <br />10824 <br />PERMIT NO.22-4_ <br />The Undersigned /� /,'.�y!t H q N/ t <br />Hereby applies for permission to /'Oiv S T.? C i n ill' "v✓ <br />At the following location 5 U i, !I 3 ter' Sf S ic <br />SKETCH <br />(Work to be done) <br />DRIVEWAY SEC110N <br />NO SCALE <br />tI" LIP <br />—_ <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 15-JHBI I <br />24 HOURS REI ORE CONSIRUC110N <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />ate _ - <br />Remarks <br />Note: <br />f �L <br />Nl (A f /I ,t e <br />Original to Customer' <br />1 Copy to File 1.0824 <br />1 Copy to Inspector <br />M <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 okppicant <br />Address <br />Fne 4— 30>6 <br />Telephone umber <br />Fee l O <br />Dept. Approvals <br />CS <br />Engineers E <br />Communications <br />Approved by <br />Date Approved <br />