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' everett <br />. e� <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />APPLICATION FOR RIGIiT-OF-WAY USE PERMIT <br />• 11209 <br />PERMIT NO, 7� ' / �3 <br />TheUndersigned '-_ _-�.--'_��..�( ` �"`�-�l l N � v i� ^.tiy-�,...� <br />k <br />Hereby applies for permission to c "_ � � =-> z �? . �' — r-- -- -.� � � <br />! <br />At the following <br />(Work to be done) <br />-�'ti.vU � 1JE �c:� (� !�!J c��-F -_`., I k��, � ��i� 1�//JC� COIJF 1 GU �k'�-I10t{� <br />�1��T ��cr��Js �UEC.1uAiE �PACF, ��� v�1-}iCt_.E Tvi2l,i i:��OU�: <br />��A���iC, 'l �l ,�Ck�7/�Jc_� <br />DRIVEWAY SECTION <br />NO SCALE <br />I�- ,25' _- ---{ <br />�I" LIP -�� <br />30" � � 30�. <br />----�-�---�i---i <br />COPY OF THIS APPLICATION TO <br />�E 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 />Ins ignature � <br />� / <br />_l �4U� `7� <br />ate <br />Remarks <br />��_; 6L i c � .;�'�= � <br />11209 <br />IN$PCCTOR'S COPY <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and all <br />claims for damages that may arise because of installa• <br />tion and maintenance of the improvement hereto <br />applied (or and further agrees to remove same upon <br />notice from the City and t�replace public properry <br />damaqeV�er�. n � 1 ` <br />v � <br />Sgnature �� <br />f APPlican[ �-. <br />�<,_ �_ �l <br />P,ddress E` "� <br />LC� —Z��� <br />Telephone Number <br />�— X—'S� <br />Date - <br />Dept. Approvals <br />Street _ <br />Communications_ _ <br />Traffic _ <br />Plannina <br />r, <br />APproved by ' . ����.. I .. . ., <br />;,f�, . <br />Date Approved ���- � . 0 <br />�' <br />