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_ �: <br />�-. <br />p�mtcli <br />�.�., <br />C�j� <br />CITY LNGINE[RS <br />EVERETT, Wl1SHIIJGTOtJ <br />The Undcrsi9ncJ <br />Hereby applics fo <br />NPPLICF�TION FUfi fiIGHT•OP•t'�'l�Y US[ PER�1f� <br />liosa <br />PCRMITNO. 77 ?`-��' <br />At ffic following location Z S/ Z f!/J%�. �.�J/� — <br />(Work to bc donc) <br />S�c f�ilACKFb <br />4� fn Gonst/-„��-�5 <br />DR!YL'„'Ay SECTION <br />NO SCALE <br />� � <br />���� LIP � <br />� �� T �— "1'30 `j <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON J0651T[. • <br />CALL ENGINEERING DEPT. 259 8811 <br />24 HOURS �[FORE CONSTRUCTION <br />CHECK LIST <br />� Watar Valve • '. .• � <br />Draina9c . . <br />Curb & Gutter <br />. Sidewa�k � <br />Inspecror's Sipnawre <br />Remarks <br />Note: Original to Customcr <br />1 Copy tn File 110 5 S <br />. 1 Copy to Impector <br />The undersiqncd ownen c�reby a9rees to hold and <br />save harmless ihe City of Everett from any and ail <br />elaims for damages that may arise because of installa• <br />tion and maintenance of the improvement hcreto <br />applied for and further agrees to remove same upon <br />notice from Uie City and to repiace publie property <br />da�}�j d� thej e�y. <br />�_/'�r!�l � �:.Q- • � �.✓�..- <br />SignaWre o( App�ailt <br />/ol.�-� �a•,� h.. <br />Address � .� . - ``/' /���� . <br />_�s ��.Ci2/l7,- �� ...� <br />Telephone Num6er � <br />353-39s?� <br />Date <br />Fee � <br />Dept. Approvals <br />Enginccrs� Z �C-t:,✓ _ <br />• Street <br />Communications <br />, Traffic <br />� Planning � <br />Approved by <br />