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everett, <br />� <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />The Undersigned _� � !%' <br />Hereby applies for permission to _ <br />APPLICATlON FOR RIGHT-OF-WAY USE PERMIT <br />At the following loca[ion " " ! '�� J. j-1 �' �_ ; +..�i /��": <br />(VJork to be done) <br />DRIVEWAY SECTION <br />NO SCvLE <br />�� —� �� <br />� +I'� Lir � � <br />�.,3�J._--__—____--}•3° -I <br />� f .�..:�'?,= � <br />% — --' , i 77 <br />� � �. ; -I . � r� G� l, <br />�COPY OP THIS �PPLIG"�TION TO I <br />BE POSTED ON J06SITE. . <br />ALL [NGINEERING DEPT. 259 �811', <br />�"� HOURS QEFOR= CGNSTR��C I ION', <br />. CHECK LIST �,,;✓ <br />Watar Valve � <br />Drainnge � � I � <br />Cur6 & Gutter ��� � � � <br />Sidewalk � <br />ri <br />, . <br />Inspector's Signature <br />Remarks <br />Note: Original to Customer <br />1CopytoFile �n7q5 <br />7 Copy to In;pector <br />10785 <br />PERMIT NO. �-' �� ���. <br />The undersi9ned owner hereby agrees ro hold and <br />save harmless the City of Everett from any and all <br />claims (or damages that may arse because of ins[alla� ''-� <br />tior znd maintenance of the improvement hereto 'i <br />app.ied for and further a9rees to remove same npon <br />noUce from iF.e City and to replace public property � <br />dama5ed [her � <br />—���,�v' _ , <br />Signature of Applicart 9_ � i��� � <br />— /ji 7.0 � %[ . e_, � ' fl� � <br />Address <br />4�d`-- /3G 7� <br />Tele;�P�une �lumber 7 <br />_ g-�!_-7 _ <br />Uate / 1--rj � <br />Fea <br />� � ,�?;� <br />Dept. A�p�ovals <br />� � <br />En9ineers ��✓�� <br />wz�e� �.l 1 <br />$Veet ^. _/i'� ..� l�,G�-9� <br />lraffir. <br />P!anning <br />_ ��+-n-� ��..�-et3^ ��i•iL �c.0 <br />✓ <br />Approved by <br />Ua:e Approvcd <br />