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APPLICATION FOS? RIGIiT-OF-Y�AY USE PERMIT <br />everett <br />� <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />TheUndersigned ��= i�"�����% Ni;:�,_sc.� <br />Hereby applies for permission to C'c � STA°a: i" r1 'L 3� <br />At the following locatiun�! (� L/tn� � l � l71 <br />(Work to be done) � � � <br />DRIVEWAY SECTION <br />NO SCALE <br />� � <br />I" LIP � <br />30'�__--- _ _ —.� 30� <br />COPY OF THIS APPLICATIUN l0 I <br />BE POSTED ON JOBSITE. <br />CALL F�•JGI�IE[RING DEPT.259-8S1 l l <br />';��i i�i�:i��ns�- �.�.r_ro��r_ cui�!sTRucTioni� <br />'� — - <br />CHECY. LIST <br />Water Valve <br />Draina9e , <br />Curb & Gutter <br />Sidewalk _ I <br />I nspector's Sign aeu re <br />t—'� � �I"�F=j� <br />Note: Original to Cusmmer <br />1 Copy to File '� �? i; � <br />7 Copy to Inspector <br />so�gy <br />FERMITNO. / /'��I <br />� <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Evere[t from any and all <br />claims for damages Ihat may arise because of installa� <br />tion and maintenance ot thc improvement here[o <br />applied for and further agrecs to remove same upon <br />notice from the City and to replace public property <br />damage y. <br />c <br />Signature of Applicant �- <br />S � . �. � — /.' O�� �G� <br />Add/ne2 � <br />4s� - /� � 7 <br />TelephoneNum�r �/^ �y� <br />S� i <br />Date �.J <br />�i = h�� <br />Fee � � <br />Dept. Ap rovals <br />Engineers �� 1� �-%�K- -1'" <br />Water ��'t;�'� �`>. �,oa�r,,./..<. ��� �✓ <br />�'� y�4� ' <br />-7� , <br />Street iT�'� — � S/i q /� � . <br />Ccmc.unications <br />Traffic <br />Planning /q' / � /� <br />C.: ..�: �( �l91/,A. Ai/(w-�vA � .. �"J i/.1�' _ <br />:� <br />Approved hy <br />utrte Apprwed <br />