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� <br />everett <br />-�e <br />CITY ENGINFERS <br />EVERETT,WASHINGTON <br />The Undersigned �`YS�C'. <br />Hereby applies for pertnission to <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />10094 <br />At the following location �'� �/ F���ClC ��L--� v� <br />(Work to be done) <br />N <br />No s� <br />i• <br />� <br />� <br />S <br />EDGE U F ' <br />Ek1.ST/NG P/di/EMENT <br />DRIVEWAY SECTION <br />NO SC`ALE <br />�— �J / � <br />I" LIP <br />r;��� � ���30�� <br />COPY OF THIS APPLICATION TO— j <br />BE PUSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 253�8871 <br />3d HOUflS C4EFORE CONSTRUCTIO� <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />ASPN . RA�SE(� <br />ED�� <br />..('i�. �%yi c2�� i .2 -i � - -�5�_ <br />Inspector's SignatuYe <br />Remarks <br />Note: Original to Customer <br />1 Copy to File �_ � O 9 q. <br />1 Copy to InsNector <br />io� <br />7q.-2o7 <br />PERMIT N0. <br />NEW ASPHALT D/Ini <br />40TH ST. <br />. �-. ..n �l�:.:.: <br />�� — <br />� I The undersigned owner hereby agrees to hold and II <br />save harmless the City of Everett from any and all <br />claims for damages that may arise because of installa� i <br />tion and maintenance of the improvement hereto <br />� applied for and further agrees to remove same upon iI <br />��,., � notice from the City and to replace public property <br />damaged ,herehy. I <br />���r7�d S4'�' Z.vc <br />igna ure of pplicant , <br />l 30� �'��/wool 19 G P �I <br />Address i <br />� . i" ^ Z i i/ <br />Telephone umber i <br />�a-v-�� ; <br />f+(,l� ��� Deee �� GC �G� — _ %�' <br />( t, '� /j' � Dept. Approvals ' I� <br />Approved by—"%��/'� <br />� �� <br />r <br />Date App— ro�� j/ �� <br />