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� evereH
<br />.. �
<br />CITV ENGINEERS
<br />EVERETT, WASHINC.TON
<br />APPLICATION FOR RIGHT-OF•WAY USE PERMIT
<br />1138�
<br />PERMIT N0. �� -. S� <
<br />TheUndersigned_ . !:�n . --(��;--! �� ��
<br />Hereby applies for permission to - ,., 1 n' �,, r c^ 1
<br />-- " ' .. � � ., . i �
<br />At the following locatiun_ :���'-vs•' ; , , , ,� � . - , , _�
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<br />(Work to be donel "" �1 %.-�."' ;'�i � � - _ - r i �-,
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<br />DRIVEWAY SECTION
<br />NO SC4LE
<br />� VI" LIP �
<br />30" i __._ ____ I 30��
<br />—__�}.
<br />COPY OF THIS APPLICATION TO
<br />BE POSTED ON JOBSITE.
<br />CALL ENGINEERING DEPT. 259-8871
<br />24 HOURS BEFORE CONSTRUCTION
<br />CHECK LIST
<br />Water Valve
<br />Drainage
<br />Curb & Gutter
<br />Sidewalk
<br />Inspector� 'gnature
<br />Cc� - �1 ���'� - 7 S�,
<br />ate
<br />Remarks
<br /><, _
<br />. ----�;'�:--�-rT:`'�`lZ'�T`'�z:`-=.�,5�_!-'_J >
<br />The undersigned owner hereby agrees to hold and
<br />save harmless the City of Evere[[ from any and all
<br />c�aims for damages that may arise because of instaila�
<br />tion and maintenance of the improvement hereto
<br />applied for and further agrees to remove same upon
<br />notice irom the CitY and m replace public property
<br />damaged thereby.
<br />Signature ot Applicant ,
<br />�. .., i_�(t, �
<br />Address
<br />. .� . .r ' - _.;�
<br />Telephone Number
<br />Dept. Approvals
<br />Communications
<br />Plann
<br />11383
<br />.�pproved by i, � �
<br />_ ,;� �,� )J�., ,. �� , � ,x�
<br />Date A ' ' .�/
<br />iiJSF[r,TOR'S �OPY PProved .� .
<br />, , .'
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