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l <br />� evcretl <br />; � <br />CITY ENGINEERS <br />F.VERETT, WASHINGTON <br />j - <br />TTte Jndersigned _ -'��'� � <br />Hereby applies for permission to _ <br />At the followinp location=- __ <br />(Work to be done) <br />APPLICATION FUR RIGHT-OF�WAY USE PERMIT <br />DRIVEWAY SECTION <br />(� NO SCALE <br />I—_ -_ _. __ _. _ _ _-� <br />�' lI P - <br />_ —, __ _'��� <br />�30.� T---__—�30"� <br />t�.UP`( UI- TI-iIS P,FPLIC�I�ION Tll <br />� ' POSiED ON JOOSITE. <br />�.,I I. I�flGI'-n�� RING [)SPT. ?'�°�;i�' I 1 <br />.�i li(WH`; Hf I�iHt. Cr)A',I'�i"�IIr);:�. <br />Inspector's SignaNre <br />�ate <br />� ; <br />`� �. <br />f'�� , i . ���—'�:� ry�(1 . .�' ./,✓�.A <br />!. ` Y., <br />Remarks <br />No�e: Original to Customu <br />I Capy ta F dc <br />1 Copy �n Inip��[1�'.r <br />` 1CJ16 <br />..__,�,.+:::_�... <br />i �' � <br />PERMITNOy_ � ' - ' _ <br />� <br />Thc undersi�ned owner hereby a9rees to holA and <br />save harmless the Ciry of E�crett from any and all <br />r.laims for damages that may arise because of installa� <br />tion ard maintenance of the improvement heretu <br />applied fo; and furthe� agrees to remove same upon <br />notice irom ihe Ciry and tu replace public prope�ry <br />damaged ihe�r.by. <br />Signature Lqpp�nt � � <br />�<, /�'._ <br />,.. f.-f- . __-�-'� <br />Address -- <br />''LCL_--�_,�,�[�''j ��H,:� <br />Telephone Number <br />Date -- 77.5- �S�J�---- <br />. , .� ,� � <br />—__..___ —___.___—__'____._' <br />Fec , _ � - --� ------ <br />� Dept. Appravals <br />/ <br />E ngmcers. __.—_. - .. . <br />___ ' .____.._. __._ <br />_ __ <br />W�Ier__._... <br />Street -..-----------� <br />Commun{cations � <br />Traffic <br />Planning _� _ _ <br />llPproved by <br />._-__ . _—._._.___.._ —_. . . .. <br />Dnlc Approvirl <br />