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caerclt <br />e <br />CITY ENGIN[ERS <br />EVERETT. WASHINGTON <br />APPLICATION FOR RIGHT-OF•WAY USE PERMIT <br />10991 <br />PERMITNO. �� 3 /J <br />The Undr.rsigned _L� �-.. r;,' ' i � "� i ,.� :: ,�.�_— — <br />Hereby applies for permission to r. �iv �r� „� � ��"' ri G�'ili} �, j [%��<, __ <br />At the tollowing Iceation ! I� ?� 1? ii ^? f7..P�yJ A i i ( n'. .sc - i °�l,., � <br />SKETCH <br />(Work to br. done) � <br />S,t� R�r; q� y� ,a <br />DRIVEWAY SECTION <br />NO SCALE <br />r--- --- - - � <br />1" LIP <br />�3Q'� .. _ .. _—_..�.30 � <br />COPl' OF THIS APPLICATION TO '� <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 259�8611 II <br />. •': riOURS� F;'FORE CONSTRUCTIQN'. <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Guttcr <br />Sidewalk <br />:nsprtoi s Signature <br />Remarks <br />Note: Original ro Customer <br />, �°��Y ta F��� 10 991 <br />1 Copy Ic Im.,r.�_:ur <br />The undersigned owner hereby agrees to hold and <br />save harmless lhe City of Everett from any and all <br />claims tor daniages that may arise becausr. oi installa� <br />[ion and maintenance ot the improvement hereto <br />app�ied for aad �urther agrees to remove same upon <br />notice from th - it an `ro replace pubtic properry <br />damaged tt y. <br />� �-- <br />Signature oF Applicant <br />Addr�/ u L�/f `7��2�� <br />%fu�c� <br />Telephone Nyqisb�_y/y,C <br />3 <br />Date <br />Fee ���. . <br />Dept. Approvals <br />� ��� <br />Engineers�__ �� � � ��. - <br />. - <br />Ccmmunications <br />A,>(����Cd �Y <br />D,ita Al�p�uval�. �_� �_ . � <br />