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EVERETT, WASHI <br />TheUndersigned �y"!^�-�fi<�� .�.1�L'�'����� <br />. �� , <br />Hereby apPlies for permission to _ T r � � "' i� ��� �— - <br />At the following locatiun� Mr�/� �� �� Fl. vr> <br />(Nbrk lo be done) <br />j�!'. I'I i l/?.. i"I L/l <br />, DRIVEWAY SECTIUN <br />NO SCALE <br />', �-- --� - -� <br />I" LIP <br />� 3p� _ ._ I 30 � <br />I� —� <br />� COPY OF THIS AP?L�C�ITION "fD � <br />i BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEP?. 259�8811' <br />� 24 HOUR� I;Gi=ORE CONoI"RUCTION � <br />CHECK LIS'f <br />Wator ✓aNe <br />Drainage <br />Curb & G,.tter <br />Sidewalk <br />Inspector's Signature <br />Remarks <br />Note: Original to Customer <br />, �oPY .o F,�� 1 ��? 1 <br />1 Cop'/ to Inspecicr <br />"Rie undersi9ned owner hereby a�rees to hold and <br />savc harmless the Ciry of Everett from any and all <br />claims for da� iages that may arise because of installa- <br />tion and maintenance oi the improvement hereto <br />applied tor and further agrees to remove same upon <br />notice from the Ciry and to replace public property <br />damaged thereyy.�. �� � <br />�si r� �ri.li cl � ,(�i�r.�,L�.tr,..� <br />Si nature of Applican <br />��.ax�-�/vi:,��C� i��/�✓ <br />Address � <br />T�✓�� r-c // ���R <br />hone Number <br />Z •; } "_ '� `r C� 3 <br />Date ' <br />�� - ��' <br />Fee � r �� <br />� ep��Cpprwrals <br />Engineers���1�� J — <br />Communications <br />Plann <br />Approved by <br />Date Approved <br />0 <br />