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evcrett <br />� <br />CITY ENGINEERS <br />EVERETT.WASHINGTON <br />APPLICATION FOR RIGtiT-OF-WAY USE PERMIT <br />1O0'i.7 <br />PERMITNO. %�7- /�� <br />lhe Undersigned Mr; �. Cn��-r !tif ' Di�NN�- �l- _ <br />HerebY aPPiies for permission to i.�. i?;.�.:r ,� !'n.v: Z.= -_ ciJk �.iAt e� ti�„ ,,= 2� "Tn,�. n��� 5'i �>' �• <br />l.o.t/G .i.ii ; i-� /Jn/G ��: U/w r ii.ri� /_t"� V�vI i�� ,3....�J�,✓ <br />At the following location /�'!%l MA p. ;.�,J «✓E -� - <br />SKETCH <br />(Work [o be dane) <br />- % /'� r T�G %t�� � <br />N� T'= � , <br />��.i,}��'.. �.���r�.: (�liJvSi��,�,. <br />�,?,a,>�' ,`�i7J✓s�',� �c,�r po•,:. <br />� ��i%�� J�'= �� IS> i< f��UyJ %� , <br />�✓ ,[ : �. � y,N�-''n�,�,''� / <br />{r��� � YG,a�e,' •6're,a�•. <br />':Y <br />.. <br />DRIVEWAY SECTION <br />NO SCALE �J <br />1�-- --_ I <br />I <br />I'� �IP <br />�3� ______�l'3�1 <br />CGPY OP THIS AVPLICATIO�J �i0 <br />Be POSTED ON JOBSITE. <br />CFl�L ENGINEERING DEPT. 259-8817 <br />�' IIOURS �GFORE CONSTRUCTION - <br />CHECK LIST ' � � <br />Watar Valve ! � <br />Drainage l� j'F? ! <br />Curb & Gutter \ � <br />Sidewalk <br />Inspector's Si9nature <br />Remarks <br />Note: Original [u Customer <br />7 Copy to File � 0� a 3 <br />1 Copy to Inspector <br />f,: <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and all <br />claims fur dama9es that may arise because of installa� <br />tion and maintenance of the improvement hereto <br />applied for and `urther agrees m remove same upon <br />notice from the Ciry and to replace public property <br />damaged Ihereby. `� � ) <br />�2�� _� �G �,4 ��; ��r .-; .. �; <br />Signature of ApP�i nt . <br />` �_ <br />/b�0 / �Y G/�� ,-:� %-`—�- <br />A�dress y � ? o j <br />s' s�� .�- - s ^ ..� � G <br />Telephone Number +y <br />lo - G ' /� <br />Date <br />De�. Approvals <br />Engineers /� .. � <br />, <br />•:1 � . , _: (-' _ Water .,'..:�_� � � . i;,,.--�'�,�,-s`^-�✓ <br />Communications <br />Planning <br />� ' `' �� E � � '�n.,�' <br />Approved by <br />Date Approved <br />