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./ <br />evrrrtt <br />:.� <br />��`:� <br />CITY [NGIN�EflS <br />LVERETT, WASHINGTON <br />APPLICAI'ION FOH RIGHI'�UF�V�'AY USG PER«IIT <br />The Undcrsigned �4��trNUl"\ SKO T <br />Hcreby applies tor permission to 1; S" /•' <br />At thc tolloe�ing tocation �r�� /�' O/-. ��%1i>/P It!_1/r <br />(Work to be done) <br />SL` p�r�'AcNr� <br />DRIVEWAY SECTION <br />{.� NO SCALE <br />I � <br />�_ � I'� LIP <br />4.30-.�._. � —_—'.—_.}.30 .� <br />COPY OF TFiIS nPPIICATION TO <br />BC- POSTED ON JUC1SITfl. . <br />CALL ENGIN[EfiING DE�'L 259�6071 <br />24 HOURS D[PORE CONSTRUCTIO" <br />� CH[CK LIST <br />Watur valve <br />Drainage <br />Curb G Guitcr <br />Sidewalk <br />Inspccloi't Siynature • � <br />�1,:.� _, <br />Rcmarks <br />Note: Ori9in, I lo Customer <br />��o,,y,or�io 10986 <br />1 Copy to InspeCtor <br />10986 <br />PFRMIT N0. � !� > -' `__ <br />The undersi�ned ov,�ner hereby agrecs to hoid , nd <br />savc harmle>s the City of Evemtt from any and all <br />etaims for dama9es that may ;rise br.cause o1 installa� <br />lion . nd mainir.nance o` thc improvement hereio <br />applicd fo� and further agrees lo temove same upon <br />notice from the Ciry and to replace pub�ic pwperty <br />da�m�ac�ed t/hereby. <br />�{! �.«%:+.� ���' ? � � f <br />J _ <br />Signaturc ol lTpplicant <br />Tclephonc Numlxr <br />Datr. <br />�:.s- '� <br />Fee � ,. �.,�YC . <br />Dept. Approvals <br />4� � <br />E��ginecrs�_l � �'. +� _ <br />\'Jater <br />Communitations <br />Approved by <br />n.�, n..,........,� <br />