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evere <br /> � � <br /> CITY ENGINEERS PERM�T NO. 78^�Z � � <br /> EVERETT,WASHINGTON ' <br /> }'� ,.y�. ,J ! h•C <br /> The Undersigned /1�/✓/a l� j7 � �`�'-S v ` � �c �div� � � <br /> Hereby applies for permission to j" 70 1 ` 'L u �'� •' � �~� <br /> i' l� . � („ � �' / ' <br /> At the following location ���'� z ' '� � ` � ( ���C• r• � .3 � <br /> � . ,� �,, �� �.i� � �� 4 C� <br /> � v X c 1, �� <br /> SK CH /� `� <br /> � (Work to be done) �- I ']�(-� / � <br /> �_ .1t1S j`� � l•��� <br /> - - — — — — — — — - - -G/�"JrnT a: �Zr� _ <br /> �� �, �; .� s r� - <br /> � � <br /> °c <br /> - � <br /> \� �c <br /> ORIVEWAY SECTiON The undersigned owner hereby agrees to hold and <br /> NO SCaLE save harmless the City of Everett from any and all <br /> {,,�.�_ �.1 claims for damages that may arise because of instatl3- <br /> I � tion and maintenance of the improvement hereto <br /> �I�� LIP �� applied for and further agrees to remove same upon <br /> 3�— I_3o"� notice from tr�City and o repla public properry <br /> �----�-- - d� Fety, d'�r�--�1'" <br /> �� <br /> Sig��re of pp licant � <br /> G ��(i' � �1 S�' ivitv/ � <br /> Address - <br /> COPY OF TNIS APPLICATION TO �, ,��/- I C� G J <br /> BE POSTED ON JOBSITE. Telephone u er <br /> CALI ENGI�IEERt^JG DEPT.259-8371 � � 7� <br /> Date <br /> 24 HOURS BEFORE CONSTRUCTIO�I � �,�� <br /> CHECh LIST Fee <br /> Water �alve ,.,� � hI Dept. Approvals <br /> Drainage �� �S//�/ '� Engineers <br /> Curb& Gut[er <br /> Sidewalk Water <br /> Slree[ <br /> CQmmunications <br /> Inspector's Sic�nature ' Traffic <br /> Planning <br /> �ate <br /> Remarks 'I �,2�,5 <br /> .L <br /> Approved by <br /> 0 <br /> � CU37011�R Date Approved <br />