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���.en <br />� <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />APPLICATION FOR RIGHT•OF-WtiY USE PERMIT <br />PERMIT <br />i�564 <br />�%/<,- ! 7 <br />TheUnd�reigned �}� !" I`I P' - � <br />Herehy applies for permissian to ' t '� � � ` ""'� °'�{ �� � � <br />At the following location <br />(Work to be done) <br />� <br />'\ <br />�. ,�•''�'s <br />� � � �� " �,�r <br />� 1 �i�'`��:�'� / <br />I ;" �" l� •" . .� <br />�.�-��'F�>^', d�'",,,. <br />�F�� 4, <br />; <br />J <br />---.--�� � � <br />� [ <br />5 . F- ��Y. <br />f �.is-. - �. <br />� �'p n <we � "�`� -- <br />iN ��' <br />rS� �.�d i �/�+, <br />, c '� � % ��VJ <br />`�j� <br />I ll — <br />� s I <br />� <br />DRIVEWAY SECTION <br />NO SCALE � <br />I+--' -- <br />\ +I�� LIP <br />(30'__�._ ---�•1+-3�-.J <br />,�_+_ —..—_—_- � <br />i <br />_.._-.—. .__. .- .. _.---.. <br />�COPY' OF THIS APPUCATION TO <br />BE POSTED ON JOBSITE. <br />ALL ENG�NEERING DEPT. 259�II877 <br />I 24 IIGUii ; Gi=1=0R[ CONSTRUCIION <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 />1 Copy to File <br />1 CopY lo Inspec[or <br />���, ��.i,.! , „ <br />t�,,, n.:t� <br />%;/�� <br />k <br />� <br />�''.?& Madvr�a <br />Pr,:r�o,. �: /ot �zl <br />The undcrsigned owner hereby agrees to hold and <br />save harmless the Ci[y of Everett from any and all <br />claims for damages that may arise hecause of installa� <br />tion and maintenance of the improvement hereto <br />applied for and further agrees to remove same upon <br />notice from the City and to replace public property <br />dama t' e;" `��� <br />/ <br />S' n wre of Applicant <br />� , � <br />A dress <br />� � ? -G soG <br />Telephone Number <br />/� q-%J( <br />Date <br />;i;_��,, <br />, �.�.,, � _.. <br />Fee <br />Dept. Approvals <br />Engineers��NJC.(/'� "� � �� ' � <br />� / <br />Water �,� �y �;i/� ,� G� - ,dj� � <br />Stree[ !,. _ � ��. <br />� <br />Communications�� ��' "�' � � '�'" — :: i �, <br />� <br />Planning � ' <br />� . . 1 ��IQ�..77 �if-L:iv��. <br />1_ rY:; il� C %I 6�rvr� , <br />Approved by <br />Date Approved <br />