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everett <br />e <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />The ilndersigned ��� <br />Hereby applies for permission to <br />At the following <br />(Work to be done) <br />... '' � .. . .--_ � <br />� t i._'.'�f <br />?0•I, ' � <br />'! <br />— -I <br />�,PPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />DRIVEWAY SECTION <br />NO SCALE <br />� � <br />I�� LIP <br />r30T__ _...___ _ _ _ _—�1"3� <br />CCPY OF THIS nPPLICFITION TO �� <br />BE POSTED ON JOBSITE. <br />CAL� ENGINKRWG DEPT. 259�8811 <br />:'=1 HOURS �i[FORE CONSTRUCTION� _ <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Guttei <br />Sidewalk <br />•?, r c, <br />•� _ Ai� <br />!. <br />l — c ,� � " <br />. , . ,,, . _ r _ .. /1 . . _ <br />�' �� 1Q466 ��a <br />___- <br />PERMIT N0. <br />- <. � <br />i <br />. , . . � . ��.� <br />The undersigned owner liereby 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 />. pplied for and further agrees to remove same upon <br />notice from the City and to replace public property <br />damaged thereby. _ <br />: "i , <br />Signature of Applicant <br />. ��: � i j . . C .-. <br />Address <br />Telephone Number <br />�� _i <br />�Fee <br />a ,' . �a`j.�; <br />� � `: • Dept. Approvais <br />a � y9 �� � ,. <br />r <br />� il - <br />✓ � �''� ��' � � Engineers <br />� ,� � .,,.,�' � � �' i y � �;r ` h � � � �� �' - <br />Wa[er_ -i� . ' i: �. <br />6.�'' J��'J'' ' , . <br />f/ � � _,•�^ ' Stree[ <br />� <br />�-�` r i � . Cammunications � -i` - <br />Inspector'sSignature ' /�, ' ���- � � - � <br />,_ . Tratiic _ <br />Remarks <br />Note: Original to Customer <br />1 Copy to File � ��� f g <br />1 CopY to Inspector <br />Planning_� � � <br />Approved by � � <br />Date Approved <br />