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sarPL(CATION FOR o'^"" - <br />U <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />• . a»iB PCnM1 � <br />PERMITNQ �� �`� <br />The Undenigned L/a �nIRENCE � JE�1 NNE NALBIa C{� <br />Herebyappliesforpertnissionto CnNSTRUCT 29' C�NCKETE D/IN lalVD TWO <br />5/DEW/�LKS <br />At ffie following location ZIZO 61/C'�/�L�NI� AVE, <br />(Work to be done) <br />q �ALT - <br />NpRKIIJG <br />AREA <br />:• <br />� <br />i . ,' � <br />DRIVEWAY SECTION <br />NO SCALE <br />�-- 29---�j <br />� +I�� LIP <br />3�� <br />I _ I 7�__ 30" <br />�� m-- Z.- <br />IA� <br />� <br />zl2a <br />ALLEY <br />- q,DN�ICr Ff�k7lING <br />AI?EA �EJ(IST/NG� <br />�-1 _-1 CJ L_ <br />�_�.__�_._--.�-e___. _._�. ____"'.._ <br />.. _ .._.._ ...__ ___ .. <br />/vFw �wvGsPETE.�i��.4f' SE���,c�AcrE <br />.� <br />N/GNL�IN17 /�VE <br />%�G��Q� �X/ 5/..[//�lJ�y The undersigned owner hereby agrees to hold and <br />W/ ��G ,�WQ�k � save harmless the City of Everett trom any and all <br />claims for damages that may arise Uecause of installa� <br />� ma��* tion and maintenance of the improvement hereto <br />j J� L• applied for and further agrees to remove same upon <br />/��Z�/,s notice from the Ciry and to replace public property <br />d aged thereby. <br />�_-_—� �Yla.�4�, <br />Si CJre of Applicant c <br />.� i z .� � ;..t..�,.._ �1 <br />COPY OF THIS APPLICATION TO l Address <br />6EPOSTEDONJOBSITE. Q.L�,�i� Te'ephoneNumberys� <br />CALL ENGINEERING DEPT. 259-BII17 �_ y> _ 7s <br />24 HOURS 6EFORE CONSTRUCTION Date � <br />coN , <br />CHECK LIST -- — -- - -- �./�—%S Fee �� S(� '�fii� <br />Water Valve � <br />Drainage <br />Cu�b & Gutter <br />Sidewalk <br />I �ctor's Sig ature <br />� —�— � � <br />ate <br />Rr.maiks <br />Note: Original to Customer <br />, �oPY to F��� 10129 <br />�r <br />