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everen <br />� <br />CITY ENGINEERS <br />EVERETT.WASHIYGTON <br />APPLICATION FOR RIGIiT-OF-WAY USE PERMiT <br />10777 <br />;?%'-;� <br />PERMIT NO. <br />TheUnders�gned�,�_''�-Lit a ::+r'%,+�:-� "�< <br />� �� <br />HerebY aPPiies tor per nission to C'� l h�� ii /i �r/�) i' I�rJ �r' �i r( f� �' ti'J i7 �� i'Y ���� ��� %� i✓ <br />� <br />� � <br />�J �r �'fkhe���✓ i.%i.e%/i�� 1:.� �� j._ '".t��✓">. <br />At the following location Sri •� 1 �,. -� •�r: -�� �;+� <br />SKETCH <br />(Work to be done) <br />��'_� .. <br />DRIVEWAY SECTION <br />NO SCALE <br />� -� <br />� +I�� LIP <br />30" — _--.—_---.4.3�-.I <br />1 <br />COPY OF -I iilS APPUGaT!ON TO <br />BE POSTED ON JO[iSITE. <br />CALL ENGINEERING DEPT. 259�8811 � <br />; 2�1 iitlUR; 3EFORE CONSTRUCTIODJ� <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />Remarks <br />Note: Original to Customer <br />1CopytoFilc 1Q777 <br />t Copy to Inspector <br />� I i+� G M��r� <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and all <br />claims for damages that may arise because of installa� <br />tion and maintenance of the improvement here[o <br />applied for and further agrees to remove same upon <br />notice from the City and t� replace public property <br />dam ,ge there¢y. ��-�.' I ,' <br />.r��i.%i�-�nZ�— -- <br />Signature o j pplicax� <br />��0 9 . -- <br />Address � <br />�=�a�>�-r��` G��-i� <br />Telephone Number <br />��_ �-a - /S ��� <br />Date <br />s� - /c7 7 � <br />Fee r/J i'�:,� <br />Dep� pp�ovals <br />✓ <br />Engineers <br />Communications <br />f'�C��. 4Nrc / i�A�(7 (�1SSEL(r <br />�:c�i - �l� -r. �- ,.. �� J i� L -c Siv;/ • <br />Approved by �) , <br />� i � �_i .. ...-i._ ^-� - , <br />Date App— roved � � � <br />