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— -� - <br />everetl <br />� <br />CITV ENGINl:ERS , <br />EVERETT, WASHINGTON <br />� <br />The Undersigned 1�. � ��✓; <br />Hereby applies for permission to <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT ,; - <br />11043 � < � �� <br />ht the following tocation � S z=� ��� n� �� ��� <br />(Work to be done) <br />a <br />DRIVEWAY SECTION <br />NO SCALE <br />� +f' LIP � <br />L30�_____ —_.—_— _�30 � <br />i- <br />COPY OF THIS APPLICATIO� TO �l <br />BE POST[D ON JO5SITF. I <br />CF�L� ENGItJ[[RIPJG DEPT. 259�8811 �; <br />I?1 r10URS [�Ef-ORE CONSTRUCTIONI <br />CHECK LIST <br />Water Vaive <br />Drainagr. <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />ate <br />Remarks <br />Note: Oriyinal to Customer � � � � � <br />1 Copy to Filc <br />1 Copy to Inspector <br />0 <br />j��� � �`%i`�C� f ���1� <br />PERMIT N0. <br />�� 3�� <br />� <br />The undersigned owner hereby a7rees to hold and <br />save harmless the Ciry o( Everett from any and all ��. <br />claims for damages that may arise because of instal�a� � <br />tion and maintenance of the improvement hereto � <br />applied for and further agrees m rem e same upon � <br />i <br />notice frorr��the City and t�a pub�it property I <br />..,y��.....i_ _. � � <br />�/h "� \' s�i/I�/J <br />Address ,.. <br />,CS I1 �l <br />Telephone Number <br />� r �/:,� / ) ) <br />i <br />Date G � <br />���t%: ��� �-:-/� � <br />Fee <br />Dept. Approvals <br />Commu <br />Plann <br />Approved by <br />Date Approved <br />