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everett <br />� <br />CITY ENGINE[RS <br />EVERETT, WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />so��� �-V� �. <br />PERMITNO. ��r/��� <br />The Undersigned .S/� C!� //V � � <br />Herebyappliesforpermissionto Cd/Vsr2�rer 2 4�' /=+S�N/-7LT n l�t/ <br />At the following location 55� 5� CE�)/Y �7 VE, � <br />(Work to be done) <br />. � <br />� <br />NO SC,qLE <br />/ / � <br />DRIVEWAY SECTION <br />NO SCALE <br />f-�-- 24 7 <br />- �'� LIP <br />I-�°'�#-- —1-J'— - --I-30'�I <br />,--- - - - <br />� COPY OF THIS iJ'PLICATION TO ' <br />� :��.G POSTED ON JORSITE. ' <br />� `,'.J !�_'1 ;ir:CERINNr� �EPT. 259-8�77 � / <br />... i. "i;; i2[!..7i;1 �:��NS1ilUCTIUW� <br />CHECK I_IST <br />y��� �I <br />ddress — <br />I�''� I � <br />� <br />;—iVEW /aSpH/�LT D�l.✓ <br />'��N. <br />5505 <br />�� �� C'»� V <br />�_ C�Z T <br />!2 <br />¢�. <br />___— <br />E��� � EX/ST/NG <br />�'�9 �/EMEA! 1' <br />The undersigned owner hereby agrees to hold and <br />save harmless the Ciry of Everett from any and alI <br />claims for damages that may arise because of installa� <br />tion and maintenance of the improvement hereto <br />applied for and furtiier agrees to remove same upon <br />notice from the City and to rr.place public propn,r;y <br />damaged ihereby. <br />Signature o( Applicant <br />G <br />Water Valvc /� <br />Urainagc I , /��� <br />Curb & Gutter /� <br />U <br />� J� Telephone Number <br />I I -� ` 1 �' <br />� � � Date <br />�� �� /Z. D�� buf <br />���L ,/(//► Fee <br />n j�_Jf�V � � Dept. Approvals <br />!/�V � . <br />�' I �s� v Engineers <br />Sidewalk Water ( .' 'f,-.�. �1.� ...F.� � C.' ' _L_ <br />d' ,� <br />Inspector's SignaW re <br />�ate <br />Remarks <br />Note: Oriqinal to Customer q (� <br />1 conv to Fi!r. 10 2 7 J <br />1 Copy to Inspector <br />/Ir/' �i ��IJP...� <br />U� � <br />$(fEBi_�i•' 1� . _.] <br />Ccmmunicationsr"-� <br />Traflic� �/� ��_�������, <br />Planninalt__1_L_ ( <br />Approved by <br />Datr. Approved <br />--..�v _ : -!�= 7�, <br />� i _. . <br />t�� ( ./ <br />' <br />