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iverett <br />i_' <br />� <br />CITY ENGINEERS <br />EVERETT, WASHINGTO� <br />�,�'-��'-SPPUCATIQN FOR RIGHT-OF-WAY USE PERMIT <br />The Undersi�ned ��H �� i �-• <br />Hereby applies for permission to <br />At the following <br />(Work to be done) <br />y.: <br />DRIVEWAY SECTIUN <br />� NO SCALE <br />_� <br />+I" LIP ��� <br />30''i__- ----�30•1 � <br />—•.� <br />ICOPY OF THIS APPLICqTION TO <br />Bt POSTED ON JOBSITE. <br />CALL ENGINEERING D6'T. 259-8911I <br />IJ-7 IIOURS UEFORG COpJSTRUCTION� <br />CHECK LIST <br />Water Valve <br />Drainagf <br />Curb & Gutter � <br />Sidewalk <br />Inspector's Signature �-- <br />Remarks -- <br />Note: Original to Customer <br />, �oPY �o F��z 11021 <br />i Copy to Inspector <br />5�_ r►%>.jcH3v <br />`.�*+ <br />' " <br />etir„ � ��' ' . . - <br />v �, � <br />Z. <br />� �;:= <br />9'� .� <br />r: ". <br />%.: ` , <br />11021 <br />� <br />PERMITNO. 7 � 3 0 <br />- . The undersigned owner hereby a ree <br />:ave harmless the City of Everett9fromt ny�and al�l <br />claims for damages that may arise because of installa� <br />tion and maintenance of the improvement hereto <br />applied for and further agrees to remove same upon <br />no\tTC�from the City and to replace public property <br />dar�aGe� thereby. /'�jn� <br />/ J <br />Signart e of Applicant (�— �'' <br />7 �d �� ��/Gi't / 11.c i <br />Address <br />35-� - 7 7aU ..,.�:._ <br />Telephone Number <br />Date �— �G � �� <br />.C/ �'�� <br />� Deptf. Approv�ls <br />Engineers � !�./��. .� <br />Communications <br />Approved by <br />Date Approved <br />