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evcren APPLICATION FOR RIGHT-OF-WAY USE PERMIT
<br /> , � 11084
<br /> CITY ENGINEERS �
<br /> EVERFTT, WASHINGTON 7 7 �
<br /> ..� ERMITNO. /37�
<br /> The Undersigned_'�d�.-i �h s � f-� �� ��S 1 �,
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<br /> Hereby applies for permission to f �
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<br /> DRIVEWAY SECTION L� r��:�.lc ./� ��,,,(: ,;:�tv�; '�
<br /> NO SCALE Tli undersigne owner hereby a9rees to hold and
<br /> . __� sa harmless t e City of Everett from any and all �
<br /> � claims for damages that may arise because of installa- '
<br /> I" LIP tion and maintenance of the improvemen[hereto
<br /> I-__-30�— _ I 30.1 I applied for and turiher agrees to remove same upon �
<br /> {.__ _-- __ .}. _,
<br /> notice from the Ciry and ro repl ub'ic property
<br /> d� age th . JCel�y� Lv n 5f. �
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<br /> Si n ure of qpplicant �
<br /> � r;Ui'Y UF i i I I�.f l�PPLii::'..i liil•i i i) � �� ,,,,� � �� ��E. I
<br /> ddress orF�� � '-�-�1�' '
<br /> �,< <os i Eo oN �oesi r�. G. S"� - D �, i TvR� f��� wP ;
<br /> C/1Ll GNGINEERING DEPT. 259�R£371 ' Telephone Num er S ��� � I �
<br /> . ' !IC1�1R; �:EFOHE CQfdSlRUCiIO�i �� ���
<br /> . . Date ��—T- ---
<br /> CHECK LIST �
<br /> � Vaater Valve Fee �,i,_�� ,'�'� ----
<br /> Grainage Dept. Approvals
<br /> Curb&Gu[ter
<br /> Sidewalk Engineers � .. ;;,��� __
<br /> Water
<br /> Street��� ,`^�
<br /> Inspector'sSignaWm --- Ccmmunica/t�ions ' yf�.�-w,
<br /> ,7 a'-c�
<br /> � Traffic ih���,�,_�����y �
<br /> -bate Planning I
<br /> !�e^ - A/n/, �.. / {^/ 7 --__�''%/
<br /> r,i,, ' - '• ;�''. i
<br /> Remarks —�"`��� '��
<br /> Note: Original to Customer _ � �-..
<br /> 1 Copy to File '� •} � (� � '-'— I
<br /> 1 Copy to Inspector - Approved by --
<br /> Datc Approvcl ---
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