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APPLICATION FOR RIGHT•OF-WAY USE PERMIT <br />% 10006 <br />CITY ENGINEEHS � —�Z / <br />EVERETT, WASHINGTON PERM1IIT NO. ` <br />The Undersigned �- �-% � W ����� �-- �--� <br />Hereby applies for pe�mi�sion to S D nl STR. A 2�� �,O NL �2 �� ���� A4 <br />. <br />At thc following location ''� % 2� 1� c� ��[����_ �-- Q�� -- <br />_�_ 8 � v � rz. �y <br />DRIVEWAY SECTION <br />NO SCALE <br />�---- z.5'---- �j - <br />� I'� LIP � <br />j-30'=i-- ---�'3° ,� <br />COPY OF THIS APPLICATION TO �. <br />f3E POSTED ON J0651TE. ��. <br />CALL CNG�NFERING DEPT. 259�881I <br />24 HOURS lifll ORC CONSI RU(:TIl1P1 <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />ispector's Signature <br />�!�? .. <br />� . <br />� <br />� JEx�sT cuc�a � S�tJEWAIk <br />6 <br />_ LANE _ � <br />The undersigned owner hereby agrees to hold and <br />save harmless the Ciry of Everett from any and all <br />claims for damages that may arise because of installa� <br />[ion and maintenance of the improvement hereto <br />applied for and further agrees to remove so�ne upon <br />notice irom the Ciry and to replace public p�opertyl � <br />damaged tY�ereby. <br />1� �?}.:Tl ,, e o � <br />Signature of Applicant <br />"=< i`� l'._i�.- . ot � c. . cs <br />Address �L , � > <br />�_i.�.;.r=�.�_27*� L.(. r�..J L''�- �" `I` <br />Telephone Number <br />� - i <br />Date /2.jL� L1L�•��� �_a'��S! <br />�- _., ll�.ti <br />Fee' / <br />��F� �A /� , �{�', Dept. Approvals <br />��- <br />ateL _�� <br />� •- . _ - % 1' � <br />���� (•Jn i�L: - - l � �� j: c' <br />Remarks � � - <br />Note: Onginal to Customer <br />1 CoPy m File '1 � � � � <br />1 CopY to Inspector <br />Approved by �/�//�' � <br />!p� <br />Date Approved � jG,�� <br />7 <br />