Laserfiche WebLink
%��� ' APPLICA710N FOR f:IGHT�O�•WAY USL- PLRMIT <br /> . �.,�,f�.�� � 10� � <br /> 1�,e�,y' ' <br /> � <br /> �� �� i <br /> :ITv Cwair�celiS ^ . � a . � <br /> 3VERETI',VlASHINGTON PERMfiNO._ ? � � , � <br /> fhcUndenigned '� ' n/r' �1. 14KFL� ( <br /> � P1.�.Q__�L_ ,l� � <br /> lereby applies for permis:ion to ip(�/�T!'� e% ��.� �' � t- � I <br /> / <br /> 1t thc fullowing locatfon�%..I�i.,� ._�/..!'��Gl.�.QU ---- --- . � <br /> - 1 <br /> �KETCH <br /> Work to be dune), <br /> ssF �Tr,�cr��v <br /> �,� fd c�oyiJ���r�'�> <br /> � ��`'r �6n ' o <br /> /9� � <br /> � <br /> DRIVEWAY SECTION The undersigned ownen c�reby a9rees to hold nnd 1 <br /> NO SCALE save harmless the City of Everett from any and all <br /> � --� elaims for ama9es that may arise because of installa• �) <br /> �i" LIP � [ion and m intenancc of the improvement hcreto <br /> applicd for and furthcr a9rces to re ove samr, upon <br /> �30'� -�-3� notic f o i the Ciry nnd to r �A pu ic pr perry . <br /> r dam r hy. . . <br /> ��-+ <br /> . Sipn rc of A�plfi�nt <br /> ( D ,�Y . <br /> :OPY OF THIS APPLICATIOR TO Address r <br /> 3E f'OSTED OM J06SITE. ���� <br /> Telephonc Num6er � ' <br /> :ALL ENGINEERING DEPT.2598811 Ih�I U I7� <br /> !4 HOURS BEFORE CONSTRUCTION Date <br /> ;HECK LIST Fee <br /> Namr Valve Dept. Approvals <br /> �rainage � . Engineers <br /> ;urb&Gutter <br /> iidewalk � Warer_ <br /> ' Sircet_ .—— <br /> Communications <br /> nsper,tor's Si9naturc Traftic <br /> � • Planning <br /> tte <br /> temarks <br /> lotc: Original to Customer 110 3 2 <br /> 1 Copy ta File <br /> 1 Copy m Inspector Approved by <br /> � <br /> Date Approved �.' � <br /> I <br />