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everetl <br />� <br />CITY ENrINEERS <br />EVERETT,WASHINGTON <br />The Undersigned / � ; ii <br />Hereby applies for permission to <br />At the following location <br />SKETCH <br />(Work to be donel <br />APPLICATION FOR RIGHT-GF-I'JAY USE PERMIT <br />� <br />ORIVEWAY SECTION <br />NO SCALE <br />� ---� <br />ji„ LIP <br />I 30' I T�— �30' I <br />I'-- �T--- - ---�--- , `1 <br />� COPY OP "iH15 i\PPLICATION 1"U � <br />BE PUSTED ON JOQSIT[. <br />Ct1LL EPJGINE6RING DEPT. 259�IIII11 <br />�I9�1 IiC�LIiS f3FFOHECOP:STRUC"ilUNl <br />CHECK LIST <br />Water Valve <br />Draina9e <br />Curb & Gutter . , ; ; <br />Sidewalk ��� I� � <br />In�rec[or'S Signature <br />Remarks <br />Note: Original [o Customer <br />t f,opY to Filc '�. `i % � � <br />1 CapY to Inspector <br />;4 <br />iC786 <br />PERMITNO. /�'��I <br />" i <br />The undersigned owner hereby agrees to hcld and <br />save harmless the CitY of Everet[ trom any and all <br />claims for damages that may arise because of installa- <br />tion and mamtenance of the improvement hereto <br />applied for and further agrees to remove same upon <br />notice from the City and ;o replace public properry <br />damagec e6y. � Cl� <br />- F �nc/e /Jr�nc�6 r�u <br />Signatwe uf Applicant —a� <br />/o�o.s y1. � . / e3' o Ce�<, <br />Address - <br />4=�.�`�- /3 6 7' <br />Telephone Number — <br />4-��- 77 <br />Date �� <br />Fey �� <br />Dept. Approvals <br />� � .� , <br />Engineers�J�;,,�� �� <br />Water���t� �i-l'� ¢vors / / � � �� <br />Street�„r l�_� _-/��� _ ` <br />� <br />Ccmmunications_ <br />Planninq <br />G�. •✓ l�i� 4 � <br />! <br />Approved by <br />Date Approvc:! <br />