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evcren <br />e <br />CITY ENGINEERS <br />EVERETT. WASHINGTON <br />APPLICATION FOR RIGHT-UF-WAV USE PERMIT <br />10514 <br />PERMIT NO.___._ . _._ <br />The Undersigned �-���- _— <br />� � <br />hereby applies for permission to �� N`--�! <br />_ _ . � /'�'�L .J i . <br />At the following location! --� ���r� ---- ---�---� <br />(Work to be done) <br />I <br />�� � <br />��) <br />�i, I <br />DRIVEWAY SECTION ' <br />NO S�AI�E <br />r _ �, __ . -� <br />��_� _,I_LIP / ; <br />_- _'-- <br />�ao'�. j �-30 � <br />'.�GPY OF THIS APPLICATION TO <br />r.l- POSTED ON JOOSITE. <br />��nLL [NGIN[FRING DEPT.159ARI � <br />�. I!rni�... rr ir�.PF Cu?15fHUr11Uf1 <br />CHECK LIST <br />Water Valve <br />Drainage <br />Cwb & Gutcer � <br />Sidewalk <br />Impector's Siynauue <br />I <br />�� --- - - --- __.. . <br />�_._- ,,� _ - _ <br />__ -_____ .__. .____.. _ _ _ _. <br />Date —_ <br />Hemeiks <br />-- <br />Nour. Origmal �o Cusmmcr �. n 5 �. 4 <br />1 ��,uPy to File . <br />1 Cnpy to Intpector <br />li� l/1 I <br />�.�_�f�r� <br />�� �� r �� ../ <br />�( .'✓_. , � L. .. � <br />The undeisigned owner hureby -iyrees tc nold u��d <br />save hannless the Ciry o( Eve�eU from any and all <br />claims tor dama9es that may arise 6ecause of inslalla- <br />� i��,•�f � tiun and maintennnce of the improvement here[o <br />I�t��� I� app!�ed (or and further agrecs to remove same upon <br />,"��t L�'��/ notice frop ihe ity and :o replace publi pruperry <br />���A, (l� / �Aam�/t her .� • <br />1 � '��� /�i nat�e ot.4pPlican �Dp <br />il� _'��� 2��:��,�(fl <br />n%��=55 <br />� 3-=�J� - <br />TelepFon� Number <br />� �f <br />.__ a . - - - --- _ _ <br />Date <br />.s � . .__ . f,./. _(�7�. <br />Fee <br />� F cc-'" � <br />APproved by f/�--- %,// <br />lr <br />ontc npProved <br />1L <br />