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evcrctt <br />e <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />APP 'ATION FOR RIGHT-OF-WAY USE P' Y11T <br />10849 <br />P[RMIT NO. ! �,�__ <br />The Undersigned _. t � �- �� � i � - ' `� <br />Hereby applies for permission to ��.� ` <br />i>I <br />At the following loca[ion�_�$_:y � ,(_, �'� v�' '� !.� /� --- - <br />(Work to be done) <br />DRIVEWAY SECTION <br />NO SCALE <br />F—__— —_ _._. � <br />� \ �I'� LIP � <br />�30_ _—� ____ 30 �1 <br />_+__ ._____..._ -.}. <br />� COPY OF THIS APPLICnTIbPI TO '� <br />BE POSTEO ON JORSITE. ��� <br />�, CnLL LNGINEGRING DEPT. 7,9�8U11' <br />� ��i ia��uiis e�ioit� a��isiitt;�:ntud� <br />CHECK LIST <br />Water Valve <br />Dninaqe <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signatwe <br />bate <br />Remaiks <br />Note: Original to Customer <br />, ��,�Y �a F��� 10 � n s <br />1 Copy [o Insper.to� <br />Cfc i�Ti��i>-'J <br />� � � <br />( �. <br />Gu " -° ;- o <br />` n � ("1 l ,, '� <br />�" �� f <br />��te � i <br />r � <br />(f � ` <br />l'he undersigned owner here6y agrees to hold and <br />save harmless the Ciry o( Evere[t from any and aIl <br />claims for dainayes that may arise because of installa- <br />tion and maintenance ot the improvement hereto <br />applied (or and further agrees m remove same upon <br />notice from the Ci[y and to replace public properry <br />dam/afg id, thGer�y.���� ,T <br />��!<L G�.�-c'.. . <br />Signature of Applicant <br />l ..D �rifl� /� <br />A dress <br />�_��_ (� u S S <br />Telephone NumbeJ <br />� i� � <br />oa« � ��� <br />v <br />� ,� <br />Fee <br />Dept. �proval� <br />;� i <br />Engineers �� �;;'—t��� � <br />E <br />Dmr. Appioved <br />