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everett <br />� <br />CITY ENC!NEERS <br />EVERETT, W�SHINGTON <br />The Undersigned <br />Hereby applies. for permission to <br />At the following <br />(Work [o be done� <br />APPLICATIGN [=0R RIGHT-OF-WAY USE PERMIT <br />a <br />1p613 <br />PERNIIT N0. i��' � i � <br />_ - , 1 r>j� � ' :,,�/ <br />_ � / <br />-.�1. . An/,y.. <br />f}' S�{t u / C <br />/7i S`7��!' �}r ad <br />� - %b 'flsPhv/i P�"VevJ.]�j S <br />v <br />F/ahL�n`J \\� \ <br />Nu t�--- --- -- ----- <br />%h_' t•.�ro /b� h%s�'hJ/f <br />Q��ve�✓.3ys hav� b��,�n <br />1� Con.��r�u✓ Jn�l drL' !n <br />U� -r_ . � J�'�7� <br />DRIVEWAY SEC7'ION <br />NO SCALE <br />� —J <br />1" LIP <br />�30'�—_—_— — 30�� <br />COPY OF THIS APPLICATION T� <br />BE POSTED ON JOBSITE. <br />CALL Ed31NEERl�!G DEPT. 259�8811 <br />2d HOURS 6FFORE CONSTRUCTIONJ <br />CHECK LIST <br />Wa:er Valve <br />Dreinage <br />Curb & Gutter <br />Sidewalk <br />Signature <br />Remarks <br />Note: Original m Customer <br />1 Copy to File 'i O�� 3 <br />1 Copy to I�,upector <br />\ <br />/�/vh�'In � <br />J <br />CverSree� W�y <br />The undersigned owner herehy agrees to hold and <br />save harmless the City oT Everett from any and all <br />cl�im: for damages that may arise because of installa� <br />tion and maintenance of the improvement liereto <br />applied for and further agrees to remeve same upon <br />notic om the City �7a d to replace public property <br />dart� g theJ�!7C YY �� / . � <br />.f r'n;i/ %i/J_�.�.hi <br />/ <br />one <br />�_ <br />�c <br />uace / �,. V <br />/(� <� � �CG'. ` �� v � <br />Fee �-i;��.-,% <br />. �_: <br />Dept. Approvals <br />Enginepers <br />Water/', �"` Je'/' fSG . e �1`;F-? <br />Street ��� ' .� <br />Ccmmunications %''��-:�v ��� <br />Treffic <br />Planning �,� -�NJ�•%`� _ <br />/�.L.G � /f�Wi✓`[C�N !�� .��%� <br />Apprdved 6y � � t <br />� 'v.,�<� ��'% /7 1 <br />Date Approved � <br />