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evercn <br />� <br />CITY ENGINEERS <br />EVERETT,WqSHINGTON <br />The Undersigned <br />Hereby app�ies for permission to <br />Al [he following <br />(Work to be done) <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT __ <br />: 10693 �) <br />� ., <br />, �. <br />___�-�- <br />PERMITNO � <br />- � <br />DFIVEWAY SEC710N <br />� SCALE <br />r � <br />I � VI" UP --�� <br />4.3��f•_. —_—.—_._ I 30"�f <br />_�i'__ i <br />i_ _ _ .—_-___ _ _. . _ ._� <br />I CONY OP THIS /aPpUCAT�GN TO <br />� 8[ POSTED OiJ JO�SIl E. <br />CALL FNGIIJEERING DEPT. 259-8811 I <br />24 HOUFS BEFORf- CqNSTRLICTif7f�! � <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter " �' � � <br />Sidewalk �, , �;`�'^'��p� <br />Inspector's Signawre <br />Note: Ori�inal to Customer <br />, �o�>Y �a F,�� 10 R q 3 <br />i Copy to Inspecmr <br />rv� -J <br />1 ��V, �' �<��tf ^ <br />, ' r <br />The undersigned owner hereby agmes to hold and <br />save harmless the Ciry ;,f Everett from any and all <br />claims for damages that may arise because of installa- <br />tion and main�enance of the improvement hereto <br />appiied for and further agrees to remove same upon <br />notice from the City and to replace public property <br />damaped thereby. s' — <br />-%�:S-�C.� �, ( . <br />Signature o.jl Applicant � <br />�. i - V I i � r �� ,�, �. 1, i i <br />Address ��...J , <br />: _� ('. i I - <br />Telephone Number <br />"% 1 <br />Date <br />Dept. Approvals <br />Communications <br />Approved by <br />Datc Approved <br />. <br />