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- eve�ett <br />� <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />APPLICATION FOR RIf,HT•OF-WAY USE PE9MIT <br />109 T4 <br />'�%,�� <br />PERMIT N0. <br />The Undersigned �./ " r � /-' -4 ( !� � ,�.�.a. ���.., ,�\ �. <br />Hereby applies for permission to � � �� ' � � _ � = n /��, /tye,? r �J�,.i�_ \ �, <br />.. 5-� . I <br />At the following Ixation �/ ?O� (i-i7�ni J �} U i � <br />(Work to be done) <br />I ORIVEWAY SECTION <br />i NO SCALE <br />I {'------ -- — —`� <br />I <br />I �- �I�� LIP � <br />iI'—��__--___—__•{•3—+y <br />� COPY pF THIS A� PLICATION TO � <br />BE POS�iED ON JOE3SITE. , <br />CA11 ENG'NEERING D[PT. 259�38t 1 I <br />'� 24 HOURc 3EFORC CONSTRUCTIONI <br />CHECK LIST <br />Water Valve <br />Dreinage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />Remarks <br />Notc: Original to Customer <br />1 Copy to File � r'�1 �] [� <br />1 Copy to Inspector <br />�iGL I"��l i�L'l'%C� <br />The undersigned owner hereby agrces [o hold and <br />save harmless the City ot Evzrett from ar.y and all <br />claims for damages that may arise because of installa� <br />tion and maintenance of the improvement hereto <br />applied for a d further agrces to re ve same upon <br />notice from ie Ci'y and to reo�ubl' operry <br />damag y. <br />Signat ey ( Ap icant <br />( Q/��J �. � !_ <br />Address <br />ZS��//ZC i <br />Datc � � <br />'� 3 c� . <br />Fee <br />De.p�t�. App//rovals <br />Engineers �� !1i �L�_�ic��' <br />Street__ _ <br />Commwiications <br />Approved by <br />Date Approved <br />u <br />