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CITY E•NGINEEHS J�� ' � <br />EVERETT, WASHIPJGTUN / <br />'1f" <br />PERMIT N0. �V �� ! �" <br />The Undersignr.d _��Ld C/i J� S4 Q/ V Cl,� � <br />I�lereby applie�a for pemiission to _L����,�- r,.....5 C�i •�1)C F�l ;•i ,•, �• ( i,- i - <br />At the followinp location I�f !i L ILi, /�'Lc• �.� 1�C-�o /3 1��� <br />(Work to be done� <br />DRIVEWAY SECTION <br />� SC4lE <br />� 1��• LIP � <br />f ��--T � � <br />I COPY O' Tf115.4PPLICATION T^ <br />BE POSTE� O�I J03SITE. <br />ICALL :� ,rytiEERIPIG DEPT. 259�8811 <br />I24 L'OURS 5eFORE COMSTRUCTIOiV <br />---- -- <br />CH"cCi< LIST <br />4Vater V �Ive <br />Dr7inage <br />Cur6 & Gutter <br />Sidewalk <br />Inspector's Si9nature <br />-6ate - <br />iiemarks <br />The undersigned owner hereby agiees to hold and <br />save harmless the Ciiy of Evere[t trom any and all <br />claims for damages that may arise because of installa• <br />tion and maintenance of the improvement hereto <br />applied for and further agrees to removr same upon <br />notice from the Ciry and to replace public property . <br />damaged thereby. <br />M.- r ....t�*" v_�.: 7' <br />Si9nature of Applicant <br />_ ! '/ �' 'r' n � ., r. . � � .� .. j> i ,; <br />Address '— <br />C=. . • , . r- � �..�:� <� ���1 [. �, <br />Telephone Numher � c• ;_.� �.. ;,, �_ <br />J .,' � / �: i 9 'iL_ <br />Date <br />Dept. Approvals <br />Cummunica[ions <br />P:an <br />Approved by <br />GUSTOMSR Date ApprovEd <br />9 :.' <br />