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�L <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />PERMIT N0. � F- — � % ` _ <br />The UndersigneJ D n r r � i � G /-1 ��1 r r� r, n _ <br />Hereby applies for permission to r' o n�• � r., c t c. J I' �? h-sl h �•�i�� o� <br />� '�. a -n_ i., <br />At the following <br />(Work to be dor.e) <br />����� �'�'% <br />P�� �rz�„ <br />/ MUK1LT �O <br />�,.r• <br />�b <br />DRIVEWAY SECTION <br />NO SCALE <br />� 21' --_- —�! <br />I <br />� +I" LIP `.- <br />I 30"�1� 30�� P/L' <br />r--T---- �� <br />COPY OF THIS APPLICATION TO � <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 259�8811 <br />24 HOUFlS BEFORE CONSTRUCTIGNI <br />CHECK LIST <br />Water Valve <br />Drainage <br />Cur6 & Gutter <br />Sidewalk <br />Inspector's Signature <br />Remarks <br />Note: Original to Customer <br />, �o�Y �o F��� 'l (� 5? p <br />1 Copy to Inspector <br />J'iD� <br />L___� <br />D«��n by <br />�,�?YL.:�, "/sr��a <br />�-,��:� <br />c:='� <br />�S, �/ 7�a/, <br />r/� <br />ll'u-nnaersic�ned owner herehy agrees to hold and <br />save harmless the City of Evere.t from any and all <br />claims (or damages that may arise because of installa� <br />tio� and mainlenance of the improvement hereto <br />appiied for and further agrees to remove same upon <br />notice from the Ci�y and ro replace public property <br />�da ed tha,rg�y <br />,vn�(5!� ..�Qan�,,, / <br />Riqna�ure of Applicant <br />��ZI 4A+'� A�e c� `�c.�ti�C�.sk`Is�oi <br />Address <br />_�55 ��g3 <br />Telepfl0 C NUmber — <br />��7(. <br />Date <br />� i o , � v '- 2 �-�(�£' <br />Fee <br />Dept. Approvals <br />� Eagineers � � <br />Water �� �•e'i-S��C /3J>� <br />Street +� �� ' �� ! <br />Communica[ion5`- ��_ L . /'�;1,_f _ <br />Treffic �qC<<,€. �/.' e.�� f 3/�7G <br />Planning �� % � ��� "�- <br />SP_u/PF. N, �pL.s A�i�� <br />Approv Y�o r, /7%' <br />Date Approved <br />