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/ <br />everetl <br />�� <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />APPLICATION PUR RIGHT-0E-WAY USE PERMIT <br />��78� <br />PERMITNO. � �� �/=� <br />TheUndersigned'--�' .,'�'.., - �;.�,��-....� — <br />Hereby applies for permission to ' � �" 'r-'�� - 'i � 3 � � �� <�' = ' � �>�'-'-� <br />� <br />At the following location_ � ' '+ ? �� � %� � �- � � L� i' <br />IWork [� be done) �� �-; .P.L �-i k;, � <br />DRIVEWAY SECTION <br />NO SCALE <br />� � <br />I� LIP <br />r3�__.. —__- _ _I_30..I <br />COPY OF THIS APPI.!C^.fIUDJ TO I <br />BE POSTED ON JOCiS1T! . <br />CALL ENGINEERIfJG D[PT. 259�8871 <br />?; IfDIIRS [3EFORC CONS � i�.i1CTIOPI� <br />CHECK LIST <br />water valve <br />Draina9e <br />Curb & Gu[ter <br />Sidewalk <br />Inspec[or's Signature <br />Note: Oriyinal to Customer <br />,�o�Y�oF;�� � n788 <br />1 Copy lo Inspector <br />The undersiyned owner hereby agrees to hold and <br />�a+c harmlzss the City o( Everett from any and all <br />.:laims for damages that may arise bacause of installa� <br />tion and maint=_nance of the improve.ment hereto <br />applied for and further agrees to remove same upon <br />notice from the ny and to replar.e public properry <br />damaged t�= _ e `!� � <br />.Q CA7C i%J t t� <br />SignaWre uf A pli ant � �. „-. L� <br />gd0� �. c� � C'iLn�4 <br />Address <br />g�s—/36� _ <br />Telephone umbler <br />-.�1- %% <br />Date `/ ;-i,� n <br />� Anl�� <br />Fec <br />Dept. Approva� <br />� 7 /%% ' %. <br />Engineers � i ��{/�'��^�r <br />Warer r�f...;.,�2-.,�7�zof�. � :.-% <br />-1 ' <br />Street�� <br />' , _-�; i� <br />Communications _ <br />Planning�___�_ <br /><..,�� �/ <br />i <br />Approved by <br />Date Approved <br />