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everen <br />1 � <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT �� 13 9 �� g <br />.? <br />�,�- � / <br />PERMIT NO. <br />A <br />TheUndersigned %lnN.1-[./� /zf�HA'iffJ �(�5��' G�rQr�i���v.e At/K' .F/�O�r <br />Herehy applies for permission to ,_('D.��,�r/G1 /l� ?5�� /� �Y"��-T _�`�_ 0� U� A'iO.�tJI<�t% <br />At he fotlowing location� l%(�,�_ /�'� <br />SKETCH � <br />(Work to be done) � <br />i \, <br />' �' <br />�V <br />i . <br />:7 <br />DRIVEWAY SECTION <br />NO SCA�.E <br />f----- 75 ----j <br />I" LIP <br />30" __—_ 30•� <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON J06SITE. <br />CALL ENGINEERING DEPT.259�8811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signatu�e <br />arks <br />FILE COPY <br />ry <br />� <br />dt.:<.iJr_ r <br />r ` ' T_ <br />r <br />J � <br />,: <br />1he undersigned owner hereby agrees to hold and <br />save harmless the City of Everntt from any and all <br />claims for damages that may arise becauu of installa <br />tion and maintenance of the imprmement heroto <br />applieA for and fur[her agrees to rc'nov� same upon <br />notice from the City and to replace pub�jc�{iroperty <br />damaged thereby. ,;' - � � ' � ; ,r <br />t:>>., . ( .. !. ���;'-..�--:L. L(.���"�I <br />��y��a.,.��..�..NN���a��.,.... � � <br />��'.i' _ �. . � - `��� i <br />Address / <br />/� ``'' ;i .' C' <br />Telephone Number � <br />' � � 7 � 1 <br />Date - ' , / J � i <br />i � �.' <br />' ; � � �i <br />_� <br />Fee _"..-:-:e%11du�' ��.t i�/� 1r L !—L/+ <br />�'i.., ., ;, ,`. D"ept. Approvals-____-- � <br />Eo9ineeri .1i_'. , , . � � �� f .. � � � .� � p , i_ . <br />� <br />� � <br />. � <br />, , ;;-----;� ,�� <br />APProved by �, _ i <br />.�� 'r):' ��-� . i.r'..��.�-.1 ((_U.L+7.� �:.[F <br />Date APProved �.( ,1 �':' f�� G.O� ��� !� � <br />�.. . - -_. <br />