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1 APPLICATION FQR P,SGNT•OF-WAY USE PERMIT <br /> ever2n .�- � <br /> . e 10868 <br /> f <br /> CITY ENGINEERS <br />� EVERETT.WASHINGTON PERMIT N0. �I�— /l7 <br /> I �+ <br /> TheUndersigned_!f(�ILl3 �'1f}C�IG���On� � <br /> Hereby appiies for permission m /�c�N S !�,<✓c i i; _,__�i�p it/j�,�;" � ���/ <br /> ' At the following location 'LBrh� R��t1��v,( � oU�E�A�D t�o- qq JA�ey �IEv.I � � <br /> , _ <br />�. . � �i� f i . � _ <br />� SKETCH ' ---- . - � <br /> I IWork to be done) i <br /> � �% � !�� % j , f�:�/%�i:� <,? - �, � � <br />� I � <br /> r � <br /> 1 <br /> I <br /> I <br /> � I <br /> I �'- � <br /> i <br /> � <br /> � <br /> , DRIVEWAY SECiION The undersigned owner herehy agrees to hold and <br /> , MO SCFLE save harmless[he City of Evereit from ar�y and all , <br /> f"-- -----"'� claims for da^iages tha� may arise because of installa� , <br /> I" LIP ---� tion and maintenance of the improvemen[hereto ^; <br /> � applicd for and further cgrees ro removr.same upon <br /> � ���-- �30 notice from the City and to replace public properry ' <br /> damaged thcreby. <br /> � Signature of Applicant ' <br /> � __ __ ___ _—_. _ __ � b6(.KQ�I„ , <br /> � i COPY Of- THIS APPUC:A��IOP� 70 Address q 7�. A� •� <br /> �E POS7[D ON JOBaITC. `� /� � �c� rl� /JO�PTN [�q� ; <br /> Telephone Number— �i <br /> i CALL Ef1GINEERING DEPT. 25&8611 � j 78 — 7�3� <br /> � � ?.1 HOURS f3EPORE CUi�lSTRUCiION� Date � _ ��_ �.� � � <br /> i L _ <br /> CHECK LIST !"ee ����� � � <br /> Wacer vaive Dept. A provals <br /> � Drainage .-7 , j� <br /> Curb&Gutter Engineers �� ,� I � <br /> Sidewalk <br /> Water I <br /> Strect <br /> i , <br /> Communications I <br /> Inspector'sSignature � Trafiic � <br /> Planning � <br /> �c — <br /> i <br /> Remarks <br /> I <br /> fJote: Oiiginal to Customer . ,� � , <br /> , �o�Y �o F,�� � (t�F g — <br /> ' 7 Copy to Inspector Approyed�bY"� '. <br /> V <br /> . . � ' Date Approved "-.. . — - <br />