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evcretl <br />� e <br />I CITY ENGINEERS <br />EVERETT, WASIiINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />10937 <br />PERMIT N0._�� i2-�� <br />The Undersigned /"r":,-�-;," ' � .I ,�n� C,��t J <br />Hereby applies for permission to 5 T^ � T' � 7 0� r_' � ' �' <br />At the following location L/�' A/) [�K i l. ;_', � l�� Vi� /',.�..-, ,-�_ q <br />(Work to be done) <br />DRIVEWAY SECTION <br />NO SCALE <br />� -� <br />f �•� LIP /� <br />�30�._._.._—___-__�30" I <br />.� <br />, CO'Y OF THIS APPLICATI Of� TO � <br />BE POSTEU ON JOBSITE. I <br />� CALL [NGINEERING DEPT'. 259�8871 � <br />� 2A HOURS BEFORE CONSI'RUCTIONI <br />i CHECK LIST <br />�� Water Valve , <br />' Drainage � '� <br />� Curb & Gutter ' ' �� <br />Sidewalk ��..! � � <br />Inspector's Signature <br />at-6 e <br />Remarks <br />Note: Oripinal to Customer <br />-1CopytoFile 10937 <br />1 Copy to Inspector <br />Sc,- �I��rl�.r,-'�> <br />ihe undersigned owncr hereby agrees to hold and <br />save harmless the City of Evere[t from any and all <br />claims for damages tlia[ may arise because ot installa� <br />tion and maintenance ot the improvement hereto <br />applied for and further agrees to remove same upon <br />notice from tl it an to replace public property <br />damagerl <br />�� <br />Siyna��� i Applicant <br />�"�� �,�,/�w L�—, . <br />Addres j�v�/7-4 Gvi7� G„��75 <br />Telephone Number <br />3s'S" - -5'/�G <br />Date <br />�'�io�7 � <br />Fee ���E� -- <br />Dept. Appro Is <br />� / �. <br />Engineers_ � . �L �F��-:"" <br />Communications <br />Approved by <br />Date Approved <br />