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evcren <br />� <br />CITY ENGINEERS <br />F.VERETT, WASHINGTON <br />APPLICATION FOR RIGHT-OF-WNY USE PERMIT <br />10612 <br />PERM�"t'N0. 7G -1S� <br />The L'ndersigned �,� �ii �_ _. I .�� ,_� <: _ . %�, � - , <br />Hereby applies `nr permis>ion to ,^O h c tr ��.� f - ,Q _„� �/� D/�,�,/ � <br />I i <br />At the following Iocation ' J`/ =' ? .t; > <br />(Work to be done) <br />DRIVEWAY SECTION <br />NO SCALE <br />r--' --- — - -- -� <br />r� � I" LIP � <br />L.3�•J. —..—�30,� <br />i <br />�- - - — _ --I <br />SOf'Y' OF THIS /�PPL�Ci1llON �iU <br />�i f3[ POS�iED ON JOHSITE. ', <br />', �.ALL ENGINEERING DFPT. 259�8811 i <br />?�7 HOURS f3Ff-OfiF CONCTRUCTION I <br />CHECK LIST <br />Water Valve <br />Dninage <br />Curb & Gutter <br />Sidewalk <br />Inspecmr's Siynature <br />Uate <br />Remarks <br />�� �l C/� _ � � t. <br />The undersigned owner hereby agrees to hold and <br />sa��e harmless t.ie City of EvereU trom any and all <br />claims for damages that may arise because nf insta�la� <br />tion and maintenance of the improvement hereto <br />appiied for and further a9rees to remove same upon <br />eH� trom the Citk and to repla public properry � <br />damageil thereby. <br />,ti� -i...� ._i�_. � ��- <br />5 of Applican[ <br />�" �-�S <br />O ��y v- <br />,adare55 � /O <br />� � >�y�o�-, <br />Tele hone Number <br />�5 S � �' � Z �. <br />Date / �J�/� �) <br />� <br />Fee "� � S�y <br />Dept. Approvals <br />P ; / ^. <br />Fnninonrc . �%i. /� �r, '" % %l � „ _ <br />� <br />Communications .�f .i-,t�.%<�" 1�-�-� Fi,_. <br />Traf f ic <br />i <br />Planninn � ��: ���x, �`�� � % / <br />� <br />Notc: Original to Customer <br />, �auv t� F��� 1(t fi 1� 2 <br />1 Copy tc Inspcctor � Apprdved by <br />�� �, :-, �.__� <br />` D�pproved ' <br />