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evcrett <br />� <br />CITY ENGINEERS <br />EVERETf, WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERN��T <br />10665 <br />PERNITNO. ?b ` Z�� <br />TheUndersigned l:,,u�� � !� i'fn�-• � <br />Hereby applies for permission to 1'�.r-t.-�-� < -� � � /.�. � - �-� ���/ _ <br />At the following location_' 7= � !" i�t %,,�• - <br />(Work to be done) <br />7 <br />� � �i,' �.,i . 5 0 ��i _------- - <br />DRIVEWAY SECTION �� <br />NO SCALE <br />� � <br />I" LIP _�1 <br />30" _—_—_ _�30�� <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 259�8811 � <br />24 HOURg GEf-OR[ COPJSi�RUCTIOP!! <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />� <br />�ll�.< < �;f�� �; �� ,1, <br />Inspector's Signature <br />-� __ �.7" l% <br />_� <br />Remarks <br />Note: Original to Customer � <br />1 Copy to File '� O� 6' 5 <br />1 Copy to Inspector <br />The undersigned owner hereby agrees to hold and <br />sav� harmless the City of Evcrett from any and a�l <br />claims for damages that may arise because of inr„ila- <br />tion and maintenance of the improvement hereto <br />a�plied for and further agrees to remove same upon <br />nofice.from the City and to replace public properry <br />d maged thereby. `_%/ :" <br />�._ _. ` � '+�-�. L <br />Signature of Applicant � � ��" _ <br />`,, .�.. /"'; i 4' .Jp __I� � . <br />) <br />Address <br />--..�-_� _ �/ t?� <br />Telephone Numher <br />Date <br />j? C I � ��_L]� <br />Fe� � <br />Dep'}t�. Approvais <br />F....�nnn.� ,� i%i/J./'-Ci„' �ii / ) / <br />Water .,".-.a <.. . '"., _ <br />Communications <br />0 <br />r/� <br />�..a i <br />�Cilf�� it/ C %/-/rrn.��.c,ci��i��� �. <br />Approved b y <br />Date Appr�:ced <br />