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� CITY ENGINEERS <br />� EVERETT, WASIiIP7GTON <br />The Undersigned <br />� Hereby applies for permission to _� �' - <br />At the following <br />SKElCH <br />(Work to be done) <br />�.'.. ��i; i�,_�> �.i <br />DRIVEWAY SECTION <br />NO SC�1LE <br />�•-- — — –� <br />+I" LIP <br />�°'�----- --i-3'�-�-i <br />. COPY OF THIS APPLICA710N TO <br />BE POSTFD ON JOf3SITE. <br />�. � CAL� F.PIGIN[ERING DEPT. 25&881 i <br />� Fiouas oEr-or�r_ corisraucTiori <br />� CHECK LIST <br />� Water Valve <br />Drainage <br />'� Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />Remarki <br />Note: Original [o Customer <br />1 Copy to F ile � O� � 3 <br />1 Copy lo Inspector . <br />PERMIT N0. '� ' <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and all <br />claims for damages that may arise bec;,use of installa- <br />tion and maintenance of the improvement hereto <br />applied for and turther agrees ro remove same upon <br />notice from,t�e City and t�eplace public property <br />damagr,cj;thef�by. / <br />/�.r� /�t/> : , -����/:"� <br />Sign ure of A icant . <br />� "� . ; 'I J-'� .:.�/,�;�(�.� -- <br />Ad ress _ ` <br />�' - � �� + <br />Teleph��'e Number <br />� �i !�'� . :.� �o {,'�. .� <br />Date I' `' r ��` <br />, -> , <br />�v�� � <br />Fee <br />Dept. Approvals <br />�� � .� <br />Engi.ieers . <br />Communications <br />Approved by <br />Date Approved <br />I 7 <br />