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evereQ <br />� <br />CITY EN�INEERS <br />EVERETT, WASHINGTON <br />The Undersigned <br />Hereby applies for permission to <br />i _ <br />APPLICATION FOR RIGHT-OF-VJAV USE PERD4iT <br />;�•i ..,.. .. <br />� ��9C?� <br />PERMIT N0. '� "�/� �' <br />At the following locatnn_ � � � �-� � i � � �. ) �:7� �i r` - <br />(Work to be done) <br />�� � �(L�"������� <br />S,P'L"� --� a <br />% � ��' <br />�� <br />DRIVEWAY SECTION <br />NO SCALE <br />�— — --- --� <br />I�� LIP <br />{-3-0'�I-- � ------�-'°"-I <br />COPY OF THIS APPLICATION TG I <br />BE POSTED ON JOBSITE. I <br />CAIL ENG!NEERING DEPT. 259�8677 � <br />24 HOURS E3EFORE COf�ISTRUCTIOMi <br />CHECK LIST <br />Wator Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk _ � <br />nspector's Signature <br />�'�fa <br />Remarks T <br />No[e: Ori9inal to Customer <br />1 Copy to File � a(��7 <br />7 Copy to Inspector <br />� <br />� _ ��.� r–:-1 .�, ;.J <br />The undersigned owner hereby agrees to !�old and <br />save harmless the City of Everett from am� and all <br />claims for damages that may arise because of installa� <br />tion and maintenance of thc improvemen[ hereto <br />applied for and further agrees to remove same upon <br />no[ice from the City and to replace public,properry <br />damaged thereby. -i':- � . /� <br />II/'"'� ( <. .. " :.��, <br />�naturc of Applicant � . �. �-' � �- <br />- r. i . . ' �i� %i � /.�' ; : <br />A dress � ���—' ' <br />y <br />_ �_I - — <br />Telephone Number <br />9 <br />Dept. Approvals <br />—r; � . "-----=-- <br />Cummunic�tions <br />Approved by <br />Datc Approved <br />