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APPLICATION FOR RIGHT-pF•WAY USE PERMIT � <br /> evrren . . - . - ... . 1 <br /> � 1 i 012 ef��+ ._ I <br /> , - <br /> CITY ENGINEE�iS � I <br /> [VERETT, WqSHINGTON � <br /> PERMIT N0.__L�L 7 i <br /> The Undersigned � i.!v✓i,-;�.� : �� �� � . <br /> Herebyappliesforpertni�sionto /S i'�i�• -; -, i tfr ,. �i � �� j <br /> I <br /> A[the followi�g locatio., :% S1 /� ' r� � � �- i <br /> � �, <br /> SKETCH � <br /> (Work to be done� � <br /> I <br /> I <br /> S�-" i� r�h:, r�%�� � <br /> ; <br /> i <br /> � <br /> � <br /> i <br /> • � <br /> , ,. <br /> I <br /> DRIVEWAY SEC710N . The undcrsigned owner hereby a�rees to hold and � <br /> YO SCALE save harmless ihe City o(Everet[from any an�all � <br /> � � claims for damages that may arise because of installa- I <br /> i" LIP tion and maintenance of the improvement hereto � <br /> �„30'�_ ___ _ _ gp�� applied for and further agrees to remove same upon � <br /> -� -� notice irom the Ciry and tu replace public property � <br /> �dama ec thereby. �} � _ <br /> v Q Y � O��.p i <br /> Signature of Applicant <br /> '_ _ ro r � s- 3 �� A��p s F �'y�y <br /> ' COPY OF �Hi:; ;�PP�ICi1llOiv T(1 ' Address <br /> BEPOSI�ED ON JOSSITE. �� 7 - -�,ZO6 <br /> CALL ENGINEERING DEPT. 259�8t;� 1 � Telephone Number ; <br /> �a �iou�s r,Fro! 9— /S � l 7 <br /> , +Er.ovsrr,ucriori� p0fe <br /> CHECK UST <br /> ' Wa[er Vaive Fr.e. /Z � <br /> %����a �79i v <br /> D�ainage De�t. Ap rova s x ! <br /> C�rb&Gutter � �d� 1' � <br /> Sidewalk Engineers ! ;.�, �-� T i <br /> VJater � ; <br /> Street i <br /> � — — Communications � <br /> Inspector's S�c�natu�e <br /> ` Traffic <br /> ' Planning ' , <br /> at-6-e- <br /> Remarks <br /> Note: Original to Customer i �' <br /> � conv to F�i� 11012 <br /> � 1 Copy to Inspector Appraved by � <br /> i <br /> Datc Approved ' <br />