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I <br />' ��4eretl <br />e <br />- CITY ENGINEERS <br />ENERETT.WASHINGTON <br />APP�ICATION FO� RIGHT-OF-WAV USE PEAMIT <br />�0901 <br />�; <br />PERMITNO._1. ���' i-- i <br />The Undersigned '- � � �- 'r " �' �- ' ' <br />Heyre�byappiiesforpermissonto ���'���%'i�•������- "' �' � � �����' � '%"_� <br />D��TF;.i� - (r`�- �-C, <br />At the following location_f��%-�-�'� ' •' �' � ' <br />(Work to be done) <br />0 <br />'� DRIVEWAY SECTION <br />NO SCALE <br />��— � <br />I \ �� LIP � <br />�,, 30" _ ________ �.3p•� <br />'�� COPY OF THIS APPLICATION TO I <br />� BF POSTED ON JOBSITE. <br />'. CALL ENGINtERIPJG Df:PT. 259-L'E',t i'� <br />�, 24 I_IOUHS ¢EFpR[ COiVS�I�RUC"iION� <br />'�, CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Signature <br />Remark�, <br />Note: Original [o Customer <br />, �oPY to F,�e '� 0 9 U 1 <br />1 Copy to Inspec[or <br />-; - - .,._ ,. . - <br />The undersi�ned owner hereby agrees to hold and � <br />save harmiess tiie City of Everett from any and all � <br />claims for damages that may arise because of installa- � <br />tion and maintenance of the improvemen[ hereto � <br />applied for and further agrees to remove same upon '. <br />notice from the City and to replace public propert �� <br />d �e� r � ; <br />Sign/gf of Applicant ` I <br />—/ � ��27 �.�J 12c� �UL`:�e7"� . <br />Address I <br />353 -�7. ��- <br />Telephone Number <br />Date %+ i �� � <br />/L—� <br />Fee <br />Dept. Approvals <br />'^ <br />Engineers_ � �i�'�/'�- <br />Communications _ <br />Traffic <br />Plannina _ . . . <br />Approved by �, '* <br />Dare Approved <br />