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APPLICATION FOR RIGHT•OF-WAY USE PERMIT <br />a�arett <br />� ��10Q46 <br />CITY ENGINEERS Q <br />kVERETT, WASHINGTON PERMITNO. �v <br />TheUndersigned �fZAti;l� �2.cE1�IS4-���_ [' �_ <br />F;er�by applies for permission to �_Ot�1S"C� . A. 4� ��J]�� __ LOI.�G l� 21 �% L�',U /AV <br />At the following <br />SKETCH <br />(Wcrk to be done) <br />DRIVEWAY SECTION <br />NO S^CA�LE <br />� "til� � <br />I" LIP <br />I'_ I — 30.� <br />�1.— <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSIiE. <br />CALL ENGINEERING DEPT. 259-8F371 <br />;: � II�`URS G[PON[_CONSIRUCT!ON <br />CHECK LIST <br />Water Valve <br />Drainage _ � <br />Curb & Gultet ��- � � � <br />Sidewalk „•r"'' � <br />f•� i .{f � <br />;., . � �l>n � <br />Inspector's Signature <br /></ "l <br />ate <br />Note: Origir,al to Customer <br />i Coay to File <br />1 CoUY lo Inspector <br />Gee��v s He «n <br />C O M QLC�C <br />��t i sT <br />S\nFu-1A <br />43=%'-i <br />NE�a A-'�i <br />SI O'C �u p �}� <br />�O <br />� <br />7 <br />The undersigned owner here6y agrees to hoid and <br />save harmless the Ciry of Everett fiom any and all <br />claims for damages that may arise because of installa- <br />tion and maintenance of the improvement hereto <br />app�ied for and fu,�ther agrees to remove same upon <br />noti from t CCy nd to re ece publ' property <br />d ther y� <br />Si naturj� f A li t ,/ '/ <br />9 ` b P� � 7'" Y � <br />Addres /� u �O <br />Telephone Number � �� ' O / � � <br />Date _� _, <br />r�.�� Pd�;�.,,,�<� <br />Fee '�� L- �O �j <br />k" De t A <br />�� �, ,, � ��} p • PProvals <br />c ....:......... /�'.s„ . �,� ,, o_..- ;�i <br />Commun <br />�� 0 n 6 Appi oved by � <br />Datc� "� � <br />i/�/%'� <br />