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APPLICATIOf� FOR RIGHT-OF-WAY USE PER'YIIT <br />everett <br />�. <br />(:ITY ENGINEERS <br />eVERETT,WASHINGTON <br />The Undersigned ! ��'` ��- '�� _� <br />Hereby applies for permission to C�` '" <br />ii�325 <br />PERMITNO. �-� Tj/ � <br />=' — <br />.-- % / C-;/Z_`� <br />� ���/'��, ..�/i✓ `7rU0 <br />At the fo!lowing loca[ion_ %b L- f���� .� r�y��^"''"`"� <br />L� � G! ��� . �T:�.. '�i".' / _i�-. �2 !I J <br />SKETCH <br />(Work to be done) ( <br />i --�-- -�z � „ I� <br />�AC�C I7F Srli�Ul,'3'LK-. <br />�XISTIiJL' LLiR(5. [UTT <br />�' Sliit✓Ji�1LK <br />, .__.� ��"��=� , - <br />�.y 3 - > <br />� <br />- IL-'I <br />DRIVEWAY SECTION <br />NO SCALE <br />r--- z�,' <br />I" LIP <br />30'�___—� —__�1'3� <br />��- <br />�-p � a.�sk (�/�J <br />I COPY OF THIS APPLICAl"ION TO j <br />' [3E POSTED ON .IOBSITE. I <br />� C/�.'_!_ Ff!r,INEERING DEPT.259�6811 �,� <br />. 'I!.��,'I-;r;B'_FORFCO�ISTRUCTIOfJ�i <br />CNECK LIST <br />Wator Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />�,_ � . �� . _ <br />Ins�e� or s Si nature <br />�, ' � <br />; <br />;,� _ �- <br />atT e — <br />/9� <br />G� <br />f]�!I!i i_', 1'_ L.'.J� 1 <br />�t �, <br />1l — i l � i� :i <br />Remarks <br />Note: Oriyinal to Customer <br />,coPY�a���� � n��E <br />7 Copy to Inspector � - <br />._r;. <br />_ .�.�.'•.,:: <br />� <br />'E i�l L L7 NC. D/I.0 <br />�� <br />G <br />'i <br />i <br />. � <br />�� I <br />I! <br />/S� I <br />4 <br />�t/0 5t/�L� <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and all <br />claims for damages [hat may arise because of installa� �. <br />� tion and maintenance of the improvement hereto �I <br />e applied for and further ag:ees to remove same upon <br />notice from the City and to replace public property <br />damaged there y. <br />� �c�.�� <br />g ture o App icant . <br />Ct/ I <br />��-� 5 1�:..,�„�� <br />:.�, Address <br />C.,l,(f%LC,� /��f�� I <br />Telephone Number �7 i <br />.�.�7 ..i - `, �} �.�i �1 I <br />Date A I <br />'� � �. ��d _y�...,c.. �. %Z 13! 71 ,. <br />Fee l— � — <br />/D t. A provals /�--/ % <br />('� �� - <br />Engineerj�-(-`--���. � . ��i/�CC-�C�.� ��=�_� )', i <br />�"/..�� .� <br />Water-����. � j <br />�..__. ; _ - � <br />Aup�cvedtfY . . . , .,.., . _ <br />--------------- — -- <br />Ja[e APP�r,�ad <br />