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evcr�tL <br />. � <br />CITY ENGINEERS <br />EVEPETT. WASHI�IGTON <br />The Undersigned ��t '�, � <br />Hereby applies for permission to <br />APPLlCATION FOR RIGHT-OF-4'JAY USE PERMIT <br />'_ I�v..��i( <br />At the following location �B �% � �'%L%(J/S�N � ��. <br />(Work [o h� <br />?�Oi6 <br />PERM;T N0. " � —Iv � <br />DR/UEln/AY EXISTJIYG /�JVE/dENT <br />ANU CURII <br />DRIVEWAY SECTION <br />NO SCALE <br />�---- 23'- --{ <br />tl�� LIP <br />� 30 I _ — � � _. 30 <br />i- 'Y� <br />. _ _ ...__.. _-�----_ . _.._ __ � <br />COPY Of THIS /�PPLIG�-ilOiJ -(0 <br />I BE POSTED ON JOQSITE. <br />' CALL ENGINEER!NG DEPT. 259�881 I I <br />7a !-IO,.iR; g[pGRE.CONSTRUCTIOhJ <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gu[ter <br />Sidewalk <br />cla_`..�. . <br />Gu�a <br />N <br />NO <br />SC/�LE. <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 />ticn and maintenonce of the improvemen[ herero <br />applied for and !urther agreec to remove same upon <br />notice from the City and [o rep�ace public properry <br />damage hereb <br />.w���'�'7//� �..-�GP.1 <br />Si �nature Applicar�t <br />- --��D✓ �Z���i�i�SL �-'�v� -�.%� <br />Telephane Number <br />'3 .S"" �"-� 3 / F <br />Date <br />/j l%'�`%- �:.- ' �%�� <br />jJ �i U -�% { ' � Fee �i.5 U � �' '7 <br />F ' U Dept. Approvals <br />I-���� ..--- -_ � _ . �, ._.' <br />}•. � � �rr .�/ — �% <br />" � � ,,� �.z -� <br />nspector'sSignaWre ��r �uGl <br />io - y �y, <br />ate � <br />Remarks <br />Note: Original to Customer <br />1 Copy to File <br />1 Copy to Inspector <br />1 � � � � Approved by <br />! + <br />. Date Appr vo ed <br />OG' ."' ,2�. 7_� <br />� <br />