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everen <br />e_ <br />CITI'ENGINEERS <br />EVERETT,WASHINGTON <br />APPLICATION FOR �IGHT•OF-WAY USE PEFMIT <br />10805 <br />PERMIT NO.� f=fL�__ <br />� <br />The Undersigned k rl l� F�v /��- �- -�i�l/ _ <br />Hereby applies for permission tc ,��'ci�i =_rn J� i i-� � 3� l-� Sl�y,.:�� T /� �v� <br />r <br />At the following location �/.Su � �/-�ia-.t ✓�` S T' <br />(Work to be done) <br />DRIVEWAY SECTION <br />NO SCALE <br />r -� <br />i <br />r� � I" LIP � <br />�0,..�„ — . —..I�gp„ <br />COPY UF iHIS AFPLICATI��N TO <br />6E POSTED ON JOBSITE. � <br />Cl�l L FNGINEERIf!G D[P-� . 2!i9 Rfl i 1 <br />� � .: li�!UI;S ii�Sf O�C t;(�':��TRUC �I(lY1 <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />nspector's Si�nawre <br />Hemarks <br />Notc: Original to Cus�omer <br />,��,�Yta���� �.pR05 <br />7 Copy to Inspr.ctur <br />S _-r-' �-7 ,—�r1Gi� �v <br />The undersigned owner hereby agmes to hold and <br />save harmless the Ciry oi Evcrett from any and all <br />claims for dzmages that may arise because of installa� <br />ticn and maintenance of the iv,provement hereto <br />applied lor and further agrees to remove same upon <br />notice irom the City and to replace pubiic property <br />dam ed thereby. . � <br />;2�.n G.,,_,t-_% %;,;, ;'' � <br />� <br />Signature ot Applicant , <br />.?_'.']l(7 �Uf �i �G'�c: ��IM1IGrtiI� '��7>b <br />Address <br />���lH %�r'l� <br />Tel phone Number <br />�i•7i� -7, ��l l <br />Date • I � � /Jr �� — <br />i� '-- ,r� ..,�. <br />Fce <br />Dept. pprov�ls <br />G� <br />Engineers �-'�""" ��A ���''' <br />Wa[er 7��� <br />% <br />�.:�';,'vn,•�:�uT Sveet�-����. <br />Communications <br />T.n((:.. � a <br />Planning_ <br />T— T <br />Sr..; r� �1-;�.r-n ,/ ��r9s7+�.., r'�l �i.�. <br />Apprwed bv <br />Date Approved <br />