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everett <br />� <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY LiSE PERMIi <br />10794 <br />PERMITNO. %���G� <br />TheUndcrsigned j-',"lv� ;: _ .%•'i:�:'J,: .— <br />Hereby app!ies for permission to r�� r� !�./S� �_J(� ` ; I �;. t" � i� :� r���- : � r- '- ;> /� v <br />At the following location SG // L��. v�-`c L_ %f U <br />SKETCH <br />(Work to be done) <br />5�'� .p,;� acH��7 <br />DRIVEWAY SECTION <br />NO SCALE <br />� � <br />j1„ LIP <br />�=0�__ -- —____—�„30..� <br />r,OPY OF THIS �aPPLICATIODJ TO � <br />BE POSTED ON JOBSIT[. � <br />� l'.ALL ENGIPIF[RING DEPT.259�881 I I <br />i <br />'i �4 I iUURS Rf�-FOr1 � CONSTf�UCTION I <br />— — --' <br />CHECK IIST . � <br />Water Valve <br />Orainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />Remar6.s <br />Note: Original to Customer <br />1 Copy to Filc '� (�? n� <br />1 Copy to Inspector <br />The undersigned owner hereby agrees to nold and <br />save harmless the City of Everett from any and all <br />claims for damages that may arise becaiue of installa� <br />tion and maintenance of ihe improvement hereto <br />applied for and further agrees to remove same upon <br />notice from the City an�Q replace public property <br />bamaged thereb/.. � J � <br />� � ��� ����. <br />Si n�fi7feDo�"Applicant <br />i�/' / a � ���n G��cr. � 4i.�v <br />Address <br />3� � 7 >aa <br />Telephone Number <br />`//� L• ! 7 ) <br />Da� /J <br />/ 2 � �fl .,� . <br />Fee <br />�ept. pprovals <br />Engineers � <br />Water��r . <br />_ - _ ,i� < � �; Street �� � �H�/„� �' Z— <br />". � <br />Communications <br />Planning /(� p �l <br />��- , �:r..�-. ��o.,0i/-�-/J�� ��.+>a ��r� A�W.Y <br />Approved by <br />Da[c Approved <br />