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APPIICATION FO GH {�'F�WAY USE PERMIT r�pr� `�`���''' ` <br /> everrtt ��G J G <br /> , t� ��j r,, � <br /> CITY EN�INEERS ���1 �/ <br /> EVERETT,WASHINGTON � ylr PERMI�PaO. �O l�� <br /> The Undersigned l/�'/\l i�.. /=i��f= ) ' < l"'/!=� !'/��l�Tt i�1. ( . <br /> Hereby applies for permission to_ :%�i f"��: / ,�, - , ':r-• - .r <br /> l. / \� , r/!�/ " ��.�.1:�1-�� I�SC'{yiL-�.�/d <br /> A[the folloeving location_ ��.5/f� /F�'r� r=/ � /� ��'7-_�_�-� <br /> SiCETI.H <br /> (kYork to ba done) <br /> ; <br /> � 6� �� <br /> ����' ��3 � I <br /> ,� ��,/ � A`-:l �l 1.-ti-'� -- <br /> W ""- t i�%v'� <br /> _ /Yj " �_'r :1��d .Y✓/�l. <br /> *u - <br /> � / � � � <br /> ' P�,�,,'�-r---� �./�Y <br /> �� � �LL I O� <br /> ;'. <br /> DRIVEwAv SEC710N Tlie undersigned owner hereby agrees to hold and <br /> NO ScaLE save harmless[he City of Everett fram any and all � <br /> � � claims for damages that may arise 6ecause of install3- <br /> �— +i" Lip tion and main[enance of the improvement hereto �` <br /> li <br /> 4,30'�_ _I 30" I applied for and further agrees to iemove same upo� ✓ ,_. <br /> notice from the City and to replace public property , <br /> damaged thereby. <br /> a <br /> C�/ ��. � -'�,�4. �• <br /> Signature of ApplicanY - <br /> (--------�-- \- :=!•.-: - j'��:' !!-:.f.� L\�'/= <br /> ; :OPY OF THIS APPLICATION TO Address . <br /> ; dE POSTED 0�1 .:O�SITE. <' '�- .- • /i J <br /> �� Telephone Number <br /> ; CALL ENGINEERING D'ePT. 25&a811 J/ ; �,. � �� �`'.-•/ i;� <br /> I 2t HOURS BEFORE CONS7RUCTION Date <br /> i_ <br /> CHECK LIST Fee <br /> Watar Valve Dept. ApproVals <br /> Drainage <br /> ! Curb&Gu[ter Engineers <br /> ; � Sidewalk Water <br /> i <br /> Stfeet <br /> � Communications <br /> Inspector's Signature � <br /> Traffic <br /> Planninc� <br /> �Sate - <br /> 1- Remarks � � � � n — <br /> � C <br /> F. <br /> i' <br /> � APPwved by . <br /> . <br /> ,:,i <br /> �;�w��. , CUs7'OMAR DateApproved ` <br /> f'J � <br /> �� . <br />