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CITY EIMNEERt <br />EVERETT, wAA1RONliM <br />The Undengmd 4-1G <br />hereby swin for Pnntlwlon <br />At to Wn ol <br />(Work to be done) <br />W. <br />,1 ywlrr <br />A G1A/✓FS <br />P01 <br />zcvvr. <br />V,0,<zx,4 6E . <br />9/?O <br />HEw'Tr <br />rGlRS � r 1 _ 7 <br />MVEwAY SECTION <br />No SCALE <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 259 8811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Wenr Valve <br />Drainage <br />Curb dr Gutter <br />Sidewalk <br />/V <br />Inspector: ignatu <br />ate <br />Remarks <br />Note: Original to Customer 10388 <br />1 Copy to File <br />1 Copy to Inspector <br />s <br />PERMITNO. 16— <br />00, <br />T16 <br />FIB <br />r/dE rfRO,lE�9v'c <br />The undhrsigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and all <br />claims for damages that may arise because of installs• <br />ion and maintenance of the improvement hereto <br />applied for and further rees o remove same upon <br />notice from the City�GUTic property <br />dartWe�d thereby. l <br />Ix�ltlC�iL.IC�C' �i✓�ttwutwl_ <br />Signature of Applicant <br />Address <br />Telephone Number <br />Date <br />Fee <br />Approved by <br />Date Approved <br />