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everetl <br />e <br />CITY ENGINEERS <br />EVERElT.1VASHINGTON <br />APPLICATION FOR RIGHT•OF•WAY USE PERMIT <br />10764 <br />PERMITNO. %7/i3 <br />TheUndersigned !�7r� � i>l�t";. <CStre (����yDN.-}il/ <br />Hereby applies for permission to CDN i?!7 �C T A /7 ':�S .�NA� T ��i / <br />At the tollowing location / 7/ I !�✓G.S % ��2i ,. = <br />IWork to 6e done) <br />5� c �=� i'AC �a r,� <br />DRIVEWAY SECTION <br />NO SCALE <br />�- --------�1 <br />I <br />I'� LIP <br />3�- 3G" <br />i-- -r — -- -- —�- -� <br />� COPY OF THIS APPUCATION TO <br />�� BE POSTED UN JOBSITE. <br />� CALL EVGINEERING DEPT. 259�8811 <br />, 24 HOURS 6EPORF CC�JSTRUCT�iON <br />CHECK LIST <br />W Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />at-6 e <br />Clemarks <br />Nore: Original to Customer <br />1 Capy to File 1 � 7� 4 <br />1 Copy to Inspeclor <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 6ecause of installa� <br />tion and maintenance of the improvement hereto <br />a:;plied for and turther agrees to remove same upon <br />noticr, from the Ciry and to replace public property <br />da ged thereby� <br />�..e�.i�c, �S-�c,e� .�L. <br />SignaWre of Apy�ican <br />11 1 l b�..vt-f �. 1�� 3 <br />Address ' <br />3$�.'i - ilo75 <br />Telephone Nym ber <br />`�!S !77 <br />Dat� <br />� � � <br />Fee ' ' <br />Dept. ppr vals <br />Engineers _ <br />Water n � �.� .�t�� <br />r � <br />Street � �� / <br />Communications <br />Plannin� /� <br />c . � ! J�w ii �l �., �L. �. , ,�n,�_ <br />5." ii���' .Sn...,n. <br />Approved by <br />Date Approved <br />