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evcrett <br />e <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />APPLlCATION FOR RIGHT-OF-WAY USE PERMIT <br />3�0483 ���� <br />���`. <br />PERMITNO. : � -v -_ <br />The Undersigned �L.-� �.._F�%/ %fT' A' � rf-u-ry� � <br />Hereby applies for permission to _/Q�+ r</i-9!_ T � <br />�„ y� � I/1` �' / <- % hr 5�/�L � �i % .4L L- � ✓ <br />7 5` /� i= Tr i�- / ( ��i= T vr �✓•1 C'� ��il� .�lr c-� i i�� <br />At the following location / s (,{ l� 7'�.7i���'E AL�� <br />(Work ro be done) <br />2 <br />� <br />� <br />N <br />M <br />"1 <br />I <br />1- ii <br />� <br />DRIVEWAY SECTION <br />NO SCALE <br />r- - --- - -� <br />� �f� LIP <br />�30.1..- _---. _. _ I 30' I <br />—�'1' — "1 <br />COPY�OF TNISl�PPLICATION 1-O � <br />I 88 POSTED ON JOBSITE. ��, <br />: CnLL f_NrIA�[=ERING DEPT. 259-Rti i"i � <br />'�; !��� i;;;�; �ti �-0HE CONSTRUCII(�I9 <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />� l-L' '�l� r - <br />InspEc?or's Sigriaturc <br />EX/ST� <br />C.8-� <br />-_ y ,�_ \ y _ . -� - - - �—'�-_ , <br />#�vcw /G ;'1 ph c.!�Y 411 _._r � rox. zp0'.� ->� <br />_ > _ _— - �' -- ' �—t�- — PP'" _--- � _-�. <br />r/ <br />.24 � <br />I�lo irr l t <br />j."ri �/,'...�� <br />���q �i� <br />cl��• , <br />� � • � <br />�ate — <br />�y�'1�'��1%J h'AS�' f�-<� ) �j!/•r+J f�/N'.''._ <br />F�ema�ks ,� <br />Note: Orig�l t��� �� C�/�i_�� �� ?� <br />, ��,�Y ta F���� t 0�l 8 3 ;� ��� <br />7 Copy to Inspectoi <br />The undersigned owner hereby agrees to hold and <br />save harmless the Ciry of Everett frmn any and all <br />daims for damages that may arise because of installa� <br />tion and maintenance of tl�e improvement hereto <br />applied for and furGier agrees to remove same upon <br />notice from ihe City and to rePlace public property <br />dam�ihercl�y;��' /i' . <br />������✓ �-�i �i�nc� <br />Signature of Applicant '"�' <br />._�'�i'. ('f' %/7 /t'�' <br />Address <br />� =5 �-��/� j <br />Telepho9gNumber <br />— �—" / - �� <br />Date <br />/✓�d F,�. ` <br />Fee - <br />Dep . velc � <br />i p <br />Engine s �` � � �i <br />Water , . / i�l,u/�(_ <br />h <br />Strcet ����,. i;,�..� _ <br />Ccmmunications <br />� : — <br />Tra(tic - � � ;(� � _ <br />Plannii�g - _ �� � � i � , �� � 4 �/,. <br />�arn.,. �(/. � �-u � , � � <br />�,c,'y:x�"�,� � <br />N � <br />APProvedby �''-1� 6 / <br />-��.� <br />Date Ap(iroved <br />