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���u <br />� <br />CITY ENGINEERS <br />EVERETT, WASIiINGTON <br />Thc Undersigned <br />Hereby applics fo <br />APPLICATION FOR RIGHT-OF•1'JAY USE PERMIT <br />.L �' : � � <br />� V <br />PERMITNO._ �I�� /�J � <br />At lhc following location �'� fJ F �^— `T — ! owi LL <br />(Work to bc done) <br />S6E /�ri-�'r�hED <br />ORIVEWAY SEC710N <br />NO SCALE <br />� � <br />I�� LIP <br />3p'�„I,�— _ �_3� <br />i <br />COPY OF THIS APPLICATION TO <br />C3E POSTED ON JOBSITE. <br />CALL ENGINEERWG DEPT.259�fl811 <br />24 f�IOURS �EFORE CONSTRUCTION <br />CHECK LIST <br />Wator Valve <br />Draina9e <br />Curb & Guttcr <br />Sidewalk <br />Inspec�ur's Si9naWrc <br />Remarks <br />Notc: Oiiginal tn Customer r' <br />1 Copy In Pilc 1� �j �.1 V <br />1 CoPy �o Intipec�or <br />._ -' ` � `: :� <br />i,JU 1;: ��T I <br />I�I���� n����.'.,. '.�• , <br />The undersigned owner herehy agrees to hold and <br />save harmless the City of Everett from any and all <br />claims ter damayes that may arise beczuse of installa� <br />tion and maintenance of the improvement hereto <br />applied for and turihcr a9rees to remoce same upon <br />notice from the Ciry and to replace public property <br />damacr�: there6y. / <br />�J..-.'�' Cre>-s-..-cr "L �.v[ • <br />SignaWre of Applic nt <br />%O .f��r,"',L�( ffi�U �'�-� ,�R'✓uu.� <br />Addre55 � �iJ'° � <br />F'z7- 72�% <br />Telephone Number <br />7 <br />Dat�¢�� y �� �� - <br />�s'- i ,.E <br />Fee � <br />Dept. Approvals <br />Wa <br />Communications <br />Pianning <br />Approveci by <br />D�tc �ppio�eJ <br />