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evemtl <br />-e <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />The Undersigned _ l.�I"7 V I L <br />Hereby applies for permission to <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />i <br />At the following location_ 4 7 ��1�rN� �� U r� J�• <br />(Work to be done) <br />,�x isri�vr_ <br />14 <br />� n�t ur- ��nv�r7 <br />__��iN. r2�� oeA <br />c�� v�Rr <br />' DRIVEWAY SECTION <br />NO SCALE <br />i {'--- 21 � _ _� <br />I <br />, �— V ��� LIP <br />I 30" __ ���___.—�30 I <br />I '�� <br />COPY OF THIS APPLICATION TO j <br />BE POSTED ON JOBSITE. I <br />CALL ENGINEERINC, DEPT. 259�8811 <br />. 3-1 IiOUR ; 3EFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />Remarks <br />Note: Original ro Customer <br />,�o�YtoF��� 1 �234 <br />7 Copy to Inspector <br />i <br />' <br />DIA1N. BN �. `�1. <br />7- /4- 75 <br />C� �? � �u : '� <br />10234 <br />, <br />PERMITNO. '� �/� <br />N;'I�! 1�� I'H• Ui�ll <br />rv0 S�r,�F. <br />The undersigned owner hereby agrees tc hold and '� <br />save harmless the Ciry of Everett from any and all � <br />claims tor damages that may arise because o( installa� � <br />tion and maintenance of the improvement herew ��. <br />applied for and further agrees to remove same upon <br />noti from the City and to replace public property <br />da aged thereby� <br />- L F�'i�� , c1�aQd'-f�^-- <br />awrc of Applicant ��, <br />V?a, eP,. �a� MuK�G��a ��a �s ' <br />Address <br />. i"SS - //.3S' <br />Telephone Number � <br />Date / <br />f D� s J ,1x:� DCI, �/���71 � I <br />Fee i <br />j�Dept. A/pp��rovals <br />Engineers !�\ �/i�lyfit�ls�OP,..e.c_.- %—�f �S <br />Water �//.Ces�c�_ % /G �7�e <br />Commun <br />i <br />Plann <br />APPr v�d ,.%/l '✓ LliL11,l�,r/ZCfi. C' — i= /•.< <br />Date Approved <br />