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APPLICATION FOR RIGHT-OF-WAY USE PERMIT 10979 <br /> everelt <br /> e �� Z6 � <br /> CITY ENGINEERS PERMIT N0. , � <br /> EVERETT,WASHINGTON � <br /> / u � r • ,. - '?. i � r' W:S r��r:t%,}�,:/ <br /> TheUndersigned X /o� 7�� IN' � <br /> nrn�-r� An� 1�n � A �/i [ /y A �s r� <br /> HerebV applies for pertnission to �— , � �r �� , � <br /> � i � Il 'n I /-��J✓�:�' l��.vf7ith�o/NF <br /> .S � - _ � - ' � �I�r�. <br /> • � >.+'�! �L <br /> ' � l ' � L S//)._ ! P . �X- <br /> At the following Ixation . , ' <br /> SKE'fCH , <br /> (Work to be done) � <br /> <�c rl i%�CIr� :J <br /> The undersigned owner hereby agrees to hold aad <br /> DRIVEWAY SECTION save harmless the City of Everett from any and all j <br /> NO SCI+IE _ � r.laims tor damages that may arise because of installa� <br /> � -- tion and maintenance ot the improvement herero I <br /> �f' LiP � applied tor and further agrees to remove same upo� <br /> notice irom the City and to replace public property <br /> i , _p,� _ __ _ _�30.J damaged thereby. � . i <br /> � <br /> , Signatur pPlicant -- �� <br /> � i - � — <br /> �� . . Address — �/�� �, <br /> � fCOPY OF THIS APPLICATION TO � ��� �y � �, <br /> ' I BE POSTFD ON JOBSITE. � Telep one um6er <br /> •�_ � —__] 7-- <br /> � (:ALI_ ENGIN[FRING OEPT_25h 1','� � Date <br /> �� 24 iiQUHS ?LFOHG Cl1N5TFUC1�IGb1,. _�.J 'Ci . <br /> Fee <br /> CHECK LIST pept Approvals � <br /> 'Nater Valve � � = � <br /> Drainage Engineers � _ '-- <br /> Curb&Gutter Water�--�— � <br /> Sidewatk � <br /> . Street�—�—�'— <br /> Communicatiuns —_------- <br /> Inspector's Signature <br /> ---- — Traf(ic , <br /> Planning <br /> �te <br /> Remarks <br /> Note: Original to Customer 10 q�9 _- <br /> 1 CopY to File Approved by <br /> 7 Copy to Inspector __ <br /> D,.tr. ApproveJ <br />