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everett - <br />' � <br />CITY ENGINEERS <br />EVERETT, WASIaINGTON <br />� The Undersigned � �� <br />��, Hereby applies for permission to __. <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />G <br />At the following lucation `-' �= 1� C�'�,v .� � <br />(Work to be done� <br />S�r �+-t n� r�F'�y� <br />a <br />A <br />. <br />DRIVEWAY SECTION <br />NO SCALE <br />I�� —._—__ _� <br />� � �i LIP � <br />30'�__.— —_—__.�.30 I <br />�1 <br />' COPY OF TFIIS APPLICATION TO I <br />I BE POSTED ON J09SITL � <br />, CALL ENGINEERING DEPT. 259�8871 <br />24 HOURS E3EFORE CONSTRUCTION <br />. —�--- ---- ---- - ------ ---. � <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />H <br />r.: <br />� E � r� c; r E <br />Inspector'a Signawre <br />'t, �.��7: <br />Remarks <br />Note: Original to Customer <br />1 CopY lo File 1� 7 � b' <br />1 Copy to Inspector <br />107].5 <br />PERMITNO. % �" 3 L <br />�' � I <br />The imdersigned owner hereby agrees to hold and I <br />save harmtess the City of Everett from any and all �'� <br />claims for dam^��es that may arise because of installa� � <br />tion and maintenauce of the improvement hereio ', <br />applied for and further agiees to remove same upon �� <br />notice �rom t ie Ciry and to replace public property . <br />damage t n. �y. �y � <br />?� - d�✓c.t ��/, �itt! � <br />Signature of Applicant ', <br />�( 7/Z fl✓c (� Sn.��. '%f�.Z%O I, <br />Address <br />�L, � L�t�- ZI.$�� '. <br />� Telephone Number �, <br />.2- /�- 7'� ' <br />� Date � � <br />/ l% � �� _ <br />Fee <br />Dept. pp[ vals <br />p .- % <br />Engineers�_ '� � <br />Water - yl^ �.-'�-./��r. <br />— Street ' �� S % i L />�_ �� <br />Communications �i <br />Traffic <br />Planning <br />� 5 � c � ' �,�n<_..� �.,�,.;��. � . <br />Approved by <br />Datc Approved <br />