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1 <br />�� <br />c'rerett <br />� <br />CITY cNGINEERS <br />EVERETT, INASHIfJGTON <br />lhe Undersigned _� <br />Hereby applies for permission to <br />At the tollowing <br />(Work to be done) <br />nOD� IPnT�n�� ��� -'-""- <br />'+• •�...�-.. w�. rvn rt�liH 1•UF•WAY USE PERMIT <br />� <br />. <br />1020y <br />PERMITNO. !-%' %% <br />�� o� �Xi�fivc <br />A✓�v�,.r --7 <br />DRIVEW4Y SEC710N <br />NO SCALE <br />�` �s - �1 <br />� I" LIP <br />30'+�----� �-_._—_.i'_--..� <br />COPY OF 7"HIS APPUCi�TION TO <br />B'� POSTED ON JOBSITE. <br />CALL ENGIN[ERING DEPT. 250�II671 i <br />.�� HC�UI?S 13Ef-OR6 CONSTRUCTIOfJI <br />CHECK LIST T--I <br />, ; ��� /,� , �. <br />( � '' ' <br />�, Inspector's5ignature <br />I <br />f/i'� / n ' J' <br />ri �.�i�� %' _ � <br />ate <br />Remarks <br />Notc: Original to Custnmer <br />, �°�Y �° F°2 10?_ 09 <br />1 Copy m Inspector <br />,J��u,l� ,�i�-�'�L <br />J�' Z�- %S� <br />e� �; � , <br />v <br />t ,� h� <br />.,...���'. <br />The undersigneci ow�� r hereby agrees to hold and <br />save hartnless the City of Everett irom any aud all <br />claims for damages that may arise because of installa� <br />tion und maintenance of the improvement hereto <br />appliad for and further agrees to remove ;ame upon <br />notice from ihe City and ro replace public property <br />amaged tliereby� �.� � � t, <br />; i� . ..( J <br />{ ignamrc ef�Applicant � <br />i1� ii. ����'� <br />Address . <br />� � � �'S `_ <br />�� <br />Telephone Number � <br />- __ t � _ --;,:- <br />Date <br />7 a� c� c-_a�, � s <br />Fee <br />,�pprove� ' _ — <br />VQ K <br />+�/ � �. � 1"titPiF L� � � -s-7s <br />VnIC N�J�fOVCO <br />