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<br />evcrett
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<br />CITti'ENGINEERS
<br />EVERETT.WASHINGTON
<br />The Undersigned w� ��.Lfw� �7L-.f�� � i.c
<br />Hereby applies for permission to c o n c t ��, rt �-
<br />c� n C f� /� ' O-' Vv,
<br />At tlia ioilovring locotion �� 2! .� v �- r^. r n IrV c. u
<br />(Work to be done)
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<br />Note: 55'Drivewny on Crno��d�r Itd.,
<br />shou�c( be nnrrowc-d, vr vu�innee rr�u�red.
<br />DRIVEWAY SECTION
<br />{.� N-O S�4LE
<br />I I�SS' �
<br />I�� LIP
<br />30" _ �3p��
<br />COPY OF THIS APPLICATION TO I
<br />� BE POSTED ON JOBSITE.
<br />CALL ENGINEERING DEPT. 259�8817
<br />� � 24 HOURS BEFOR� CONSTRUCTION�
<br />� CHECK LIST
<br />Water Valve
<br />Drair.age
<br />Curb & Gutter
<br />Sidewa�k
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<br />I bec o��5ig� ature ��
<br />5 =/7- �%
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<br />Note: Oric�inal to Customer � � � � �
<br />1 Copy to File
<br />1 Copy to Inspector
<br />PERMIT N0. �(' i I:-
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<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 because of installa-
<br />tion and maintenance of the improvement hereto
<br />applied for and furtYrer agrees to remove same upon
<br />notice from the City and to replace public proper[y
<br />damaged thereby.
<br />�, § � �% - ` Y_
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<br />i naWre of p'p icant
<br />�I�G1 %i/r� � �
<br />Telephone Number ��,
<br />�c-�->27�' �
<br />Date
<br />�luf �42 00 �.
<br />Fee
<br />Dept. Approvals
<br />Engineers ,
<br />Wa[er� l L�.,��il ME�=xur- I1���{'tn. �,r '.
<br />Street�J �;'"... ,�
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<br />CommunicaYor�s r, �� S � �� -- ��
<br />Traffic
<br />Plannin �`� � �.
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<br />Apprpved by I !
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