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RPPLICATION FOR RtfiHT-OF•WAY USE PERMIT <br />- everett 10832 <br />� <br />CITY ENGINEERS PERMIT NO. '� � �-' <br />EVERETT,WASHINGTON <br />' ' ' �J = /•,.7.. . . <br />The Undersigned __J_[_��-:• �� , - <br />Hereby applies for permission b ��� -�i �� � ' -i J "� � � <i'j9H � F- Li'/�_- i <br />At the following <br />(Work to be done) <br />'' DRIVEWAY SECTION <br />I NO SCALE <br />'� I.— ------� <br />I —�1 <br />�I" LIP / I <br />' �30•y_ �--�.30'� I <br />-� •I <br />COPY OF TkIIS APPLICATIOIJ TO �I <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERWG DEPT. 259�581 i II <br />, Z�1 !-IOURS f?FFORE CGNSI"RUCTIONi <br />CHECK LIST <br />Watar Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspectur's Signature <br />Note: Originai to Customer <br />7 Copy to File ���.� 2 <br />7 CopY to Inspector <br />r_i.'� l: —1�-� <br />_ .: ` ", /•�C/ty J <br />. .'::Y.�.' . <br />.��V�'!"^"t'�-��`'w�"'�' i 'Y�i:� Y ^�.,. <br />The undersigned owner hereby agrees to hold and <br />save harmles, the City of Everett from any and �ill <br />claims for damages that may arise because of installa- <br />tion and maintenance of the improvement hereto <br />applied f or and further agrees to remove same upon <br />notice from the City and-�o'replace pyblic properry <br />damag�d thereby. j�� ' � <br />_�.��� <br />.:,�� ., r;,. .-,- — <br />Sigpature of A plicant i .. • <br />�-�ij .,::�r / �/.�� ,c,C� �_�.i�i �t ! <br />Address <br />-� .-c�.' /GL / <br />Telephone Nu ber <br />D�te <br />Dept.�Approvals <br />Ccmmunications <br />Approved 6y <br />Date Approved <br />