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� �; APPLICATION FOR RIGHT-OF-WAY USE PEfiMIT ;��331 <br />' CVL'fl'I� <br />� <br />CITY ENGINE[HS 7� Z -Z � <br />EVFRETi,bVASIitNGTO�V PERMITNO. / <br />' n �/ /j� <br />The Undursi9ned %.�:�. t`l i�-�i"7 �i'T' "�f/ �'� �1 �' <br />i <br />Herr.by applies for permission to -�S I"C.'I1 /.-'. - f <br />At the folloKin9 �ocation rii���L• L�C' <'�' � ��� r <br />(�Nork to be done) <br />DRIVEWAY SECTION <br />NO SCALE <br />� � <br />I" LIP <br />�.,,'�-���.___ ..4.3�� <br />� _.,— ------ --- - <br />"OPY t^,F TF'.'S i�,PPUCA710N TO <br />Ii 5[ POSTE� CN JOF.SITE. <br />� CALL ENGI�EERING DEPT. 259�8817 <br />I 24 FIOURS 3EFORE CO�STRUCTION <br />�_ - ------- <br />CHECK LIST <br />Water valve <br />Drainage <br />Curb & Gutter <br />Siciewalk <br />Insprcror's Signature <br />-6atr --- — <br />Hemarkti -------- <br />11'31. <br />� <br />, <br />��, �,,,� , � <br />; � �-, <br />� Q .�`� � <br />Cr� 1 ,� <br />ni• <br />�� � <br />The undersigned owner hereby a9rees to hold an� <br />save harmless the City of Everett from any and all <br />claims for damages tt�at may arise because of installa- <br />tion and main[enance of the improvement here[o <br />applied for and further agrees to remove same upon <br />notice trom the CiN ai��1 to replace public property <br />damaged thereby. <br />Signature of App�licta,n[ � <br />.i1,i ;•? %�Lacl."7�>,X -- <br />Addres�i rG Y � <br />,; - l - x �� 9.� '�J.�,�>»zu �a�G <br />Tciephone Number ' <br />7 � ��' - 9.? � 7 _ <br />Date . <br />�Llt C; . �'s . /�'l.�i' <br />Fce � i <br />Dept. Approvals <br />Sirce[ �� <br />Communications <br />Traffic <br />Planning <br />Appro•,ed hy <br />c�s7�r3� Date Approved <br />