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s�P�en APPUCATION POR RIuHT-OF-WAY USE PERMIT ��� <br />r � �"" �0159 <br />CITY ENGINEERS PERMIT NO. ��-�� <br />EVERETT, WASHINGTON <br />TheUndersigned �ON"i» L-✓�� _ D L�/� 1/F\1�L hNST <br />Hereby applies tor pertnission to CQNSTi2UCT 2/ '.�)Si�N.4 LT Dl7l VEb✓AY <br />Atthe following location 14-10 RA/N/ER f�iVE, <br />(Work to be done) <br />25' <br />EDGE �F E /ST/NG — <br />PLIVEMEiVT �XISI: fL9oNAL7 <br />NEW ASPNALT L�W <br />DRIVEWAY SECTION <br />NO SCAL� <br />{.�.—_— Z � � <br />I <br />+I" LIP <br />� 3p'�_. -�/ / __ __.1.30 J <br />�'— J-ftr r -i <br />COPY OF THIS APPLICATION TO <br />BE POSiED ON JOBSIT[. <br />CALL ENGINEERING DEPT. 259-8817 <br />i?�} HOURS 8[FORE CnNS�iRUC110N1 <br />CHECK LIST <br />Water Va�ve <br />Drainage <br />Curb & Gutter <br />Sidewaik <br />� �1 <br />. �, ��n , ; i <br />„ <br />���'t�t.�,�� �, ,}� �i���1�'= <br />' Inspectors$ignature <br />� <br />_ _ � � -. <br />ate <br />��f.i�. !%`i ��' I LCi�� _, ,_l, . <br />t.. .�,,J� �y �-: i�. i` <br />Remarks _ .< I i- <br />� L� .: f, <br />i; <br />,�:.-i,,.`� ,. ._ <br />/S' ' � I <br />I <br />,� , <br />I <br />i <br />i <br />i � <br />� <br />� <br />--- ; ' <br />I Q <br />� � <br />W Nn SeQL�. <br />i Z <br />I � � <br />The unciersigned owner hereby agrees to hold and <br />save harmless the City nf Everett from any and all <br />claims for damages that may arise because of installa� <br />tion and maintenance of the improvement hereto <br />applicd for and further agrees to remove same upon <br />notic om the Ciry and to re ce public properry <br />da ag�thereby. �- <br />_ � <br />i <br />i nature of App ic/� <br />Z?i0 5? L/A �� S'7- <br />Address <br />ZS2- Ll�z� <br />Telephone Number <br />� <br />Date �Q��� <br />�Q� SQ `�' Q/o ��c � <br />Fce <br />Note: Criyinal to Customer n <br />1 Copy to File 'i � 1 5:7 <br />1 Copy ro inspector AP ��,�� t�✓.t -���5"— <br />� <br />/ <br />Date A proved ' <br />