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c:crett <br />� <br />CITY ENGINEERS <br />EVERETT. WASHINGTON <br />APPLICATION FOR RIGHT•OF•WAY USC PERMIT <br />The Undersigned ___ �� �[ h c. F I ,4 A r�f � i-� a i n <br />Hereby applies for permission to _ r o �, �. t r�, c f � �°' C - � D/ i <br />At the following location__ � � �) � J C r �-� ,4 �i F <br />(Work to be done) <br />� DRIVEWAY SECTION <br />NO SCALE <br />� 23'-----j <br />� � �i� LIP <br />30'�._.--.—_—.— �30�� <br />�, COPY OP�YHIS APPLICATION TU � I <br />� BE POSTEL UN JOE3SITE. I <br />, CALL ENGINEERING DEPT. 259��811 I <br />24 HOURS REFOR6 �ONS��RUCTIOPi'i <br />� CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />Remarks <br />Note: Original to Customer <br />1 Copy to File <br />1 Copy to Inspector <br />,C-' I. <br />.(-'."��� . .. . :�- <br />c <br />10525 <br />PERMITNO. 7L� " /S := <br />k <br />40�- <br />��� <br />The undersigned 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 installa� <br />tion and maintenance of the improvement here[o <br />applied tor and further agrees to remcve same upon <br />notice from the City and to replace public property <br />damaged thereby. <br />� �� / . <br />w. � il.:tr�i a w , , <br />Si na ure o( Npp icant / <br />i '_� , . � /: 1 .. .T � �� w_ }� .0 <br />Address <br />�_l "? _ Z T/ � <br />Telephone Number <br />Date ' <br />f1,5�� �u� <br />Fee <br />Dept. Approvals . <br />Engineers�Z / ,f / <br />Water + �%PI- �e �rSc-L e %S %f'� (y c, /7��q/ <br />Street Y��ti,.�i� <br />Communi a ' s <br />Traffic .-� ' c'� � �� <br />Plannin � %� � � � <br />SPw �, �i� ,c� T�,� �,,.� Su� �s-�o� <br />10 5 2 5 qp��q(ed y <br />.ri�7_""�*!-� '_/'- e"F— <br />DatE Ap�roved v <br />4i <br />