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APPLICAI'InN FOR RIGHT•OF-WAY USE PERMIT
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<br />CITY ENGINEERS
<br />10720
<br />EVERETT,WASHINGTON PERMITNO. ���J-30
<br />?.:;si�ned ltetr r!�mber
<br />TheUndersigned ' � i���•.-/�:,��, 0,.2� n�_/,��n�
<br />Herebyappliestorpermissionto��� 3// `/UO�.� �f, E�, �� �,(-H )n/ 300��
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<br />At the tollowing locatio� _J _� � !6� ` 1S i 1� - >>��q„�-•----� �v `-" ta ✓e�
<br />(Work to be done)
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<br />DRIVEWAV SECTION
<br />NO SCALE
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<br />COPY OF THIS APPLICATION TO
<br />L'CPOSTED ON JOf3SITE. I
<br />cnl.L fNGINEERING DEPT. 259�8II1 I I�
<br />''�� 'IOiJII ; (3[FORE CONS1 f2UCTIOPI�
<br />CHECK LIST
<br />Water Valve
<br />Drainage
<br />C .rb & Gutter
<br />Sidewalk
<br />I nspector's Signa W rc
<br />6ate — -
<br />Note: Original to Customer
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<br />rCcuq n, �m:;,unini
<br />The undersigned owner hereby agrees to hold and
<br />save harmless ihe City o( Everett irom any and all
<br />claims tor damages that may arise because of installa-
<br />tion and mainrenance of �he improvemen( heieto
<br />applied for and Turth.�r agrees to remove same upon
<br />notice from ihe City and [o replace public property
<br />damaged thereby.
<br />C� c+n i?. t+(+l lm1
<br />Signature of 4pplicant
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<br />Ad rass
<br />33!�_1`;�0
<br />Telephone Number
<br />�d[e�� �• �-7 0,' ! ,, r,.F {; . 'oEl�r=�7� � J�77�
<br />Fee �"��f���"
<br />Dept. Approvals
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<br />Engineers ,
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<br />Communications �i
<br />Planning
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<br />n��������d i�Y
<br />�ate ApP��ved
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