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evcrett <br />� <br />CITY ENGINFERS <br />EVERETT,WASHINGTON <br />APPLICATIOPJ FOR RIGHT-OF-WAY USE PERMIT <br />10038 <br />PERMIT NO.�'—/�� <br />The Undersigned (� � � �- ��n � � � � l� I �._.r� ��-S <br />i — <br />Here6y appiies for permissicn to r ot�� S T i�U C..T � ��% ���-' N" -,�% '- � l I r'l. l��f _ <br />___—T <br />At the follov�ing location_ Z�� ?i ���_�l.—Y ���_l ,/1 <br />SKETCH <br />(Work to be dcne) <br />� <br />� <br />� <br />��sE,r.icwT ,�c�e <br />GHF_F1Cs� <br />ORIVEWAV SECTION <br />40 SCALE <br />i----- /�� --- _ -.� <br />�11" LIP � <br />L30'+. _.__. .. y30"J <br />i- -r- 'i <br />i�1:P':'ul flll`,.�,�,���.I�.�'., .. � <br />;��,�; � �. �� ��;, ���;,.� ��. <br />�\LL GNGINEERING DEPT. 259-8611 ��� <br />1 i{(IUHS Rf f I�Hf C(�NSTPt1Cl I[ 'I <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gut[er <br />Sidewalk � <br />�'--- _ <br />Inspector's Si9nature <br />-�,e� i- r�r ���3-�' �s <br />�I4i_IjNP_I �S�c� .t,o Co•vG ✓ <br />Remarks /�i��>iuA�.4 �MC^y3H<J �- <br />/ <br />Notc: Ori9inal to Customer <br />1 CoPy �o File 't (� (� � � ---- - — <br />1 Copy ,o Inspector Approved h i <br />Date APproved / . ----- <br />/l1�'iJ-� <br />�=xisravG -.i�c✓ticr <br />�i;u� cui�% �" �1�� <br />-___ - <br />_ �;e:���r---� �-� <br />TJ.�/G�->'t..tily .— <br />1 � <br />The undersigned owner hereby agrees to hnld and <br />save harmless the City uf Evere[[ from any and all <br />claims tor damages that may arise because ot installa� <br />tian and 'aintenance of the improvement hereto <br />`� i�.; ,' applied f and further ag� to remove same upon <br />notice ihe City and 1 replace public property <br />dama n�i �inrnhv _— l ... � <br />ZS�-OZ�E3 �...•-- <br />Telephone Number <br />8-15- I�. ---- <br />Date �� ) _ <br />/ <br />Fee ' �yL, <br />/ �! <br />Dept. Approvals <br />