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: everen <br />� <br />CITY ENGINEERS <br />EVERETT. WASHIIJGTON <br />The Undersigned <br />Hcreby applies tor permission to <br />APPLICATION FOR RIGHT-OF-�VAY USE PERMIT <br />102�8 <br />/.'� �' <br />PERMI"i NO. / -� - �U <br />At the following location -S � �3 � L � �-f N 4 ��� L.OT /3 �L .� <br />(Work to be done) <br />N <br />,1/0 -S c. A �-: <br />PL/�CE NEW I Z" CONG. <br />CULVL-K7- <br />DRIVEWAY SECTION <br />NO S�C7ALE <br />� �4 —_ <br />-'-l� �------4-'-°„� <br />�:OPY OF THIS APPLICATIO��TO � <br />.:�F POSTED ON JOBSITE. <br />��.iti'�_L [IJGif�!EERIIdG fIEPT.263-118i'� <br />, ��u:�u�;:; �rr,�,r,� coN.�nunTiop� <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />' � <br />� ��,� r; ,; <br />�;f.� ,-�= - - <br />Inspector's Signature <br />-cst� <br />`-/�-lJ — <br />_' , %�.�;�! = _'• r' ; � ': ;� � %r�'i� - , . _ < <br />Remarks <br />Noce: Original to Customer <br />1 Copy to File 1, n�% � 8 <br />7 Copy to Inspector <br />SS �/� <br />13 <br />pfEui G�rJc• A��u <br />No CURR `�-CdrT�R �r� s�w <br />r� <br />�_ <br />�1��='� ��r �X�STiti'G, �y✓�ME�/T <br />The undersigned ow�ner hereby agrees to hold and <br />savc harmless the City o( Everett from any and all <br />clain•; for damayes that may arise because of installa� <br />tion and maintenance of the improvement hereto <br />applied tor and furlher agrees to remove same upon <br />notice from the Ciry and to replace public property <br />damtaged thereby. /� <br />7��/!Y. I� V Y��..I � PC ] LN l__�_�1_-+=�-d�� <br />�i�' r y� SiriaWre of Applicant <br />s/lY �is ro 13...r 1z-c-� �.ie✓o R 98zo7 <br />� Address <br />5a3-YO�'� <br />Telephone Number <br />b-l��-�7�� <br />Date // O � � D� 3 7l � <br />l <br />Fce <br />�� t1�i <br />'%� <br />Annr�v.@�Il�v I i '- <br />JG-C , /��fl�.-i� C Le'�J w — .. -" �_S <br />Date Approved <br />