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everelt <br />.� <br />CITY ENGINEERS <br />EVERETT.WNSHINGTON <br />TheUndersigned IVIYS I�C.I' <br />Hereby applies tor permission to _ <br />APPUCATION FOR RiGHT-OF-1VAY USE PFRMIT <br />10540 <br />P�RMIT NO. /�L` �" ��� <br />At the tollowing location�f �3� W CT '.Rt f'iy_ti.__— - — <br />(Work to be done) <br />�L <br />� <br />� <br />�,�� ORIYEWAY $ECTION <br />NO SCALE <br />� �� � <br />I'� LIP_� <br />I ���� _. __ _ ____ _ I 30"� <br />r• •r- <br />COPY OF THIS nPPLICl:IIGId � J � <br />HE FOSTLD ON J01351TE ', <br />CALL ENGINEERING DEPT. 259�88 � 1�� <br />7A IIOUR.`� BEFORE CnNSTRUCTIOh;i <br />CHECK LIST <br />Water Valve <br />Drainage <br />Cwb & Gutter <br />Sidewaik <br />.s- ( 1 % J <br />Inspector's igna re �'�� <br />_�Zyi 7.� <br />-ba�� <br />Remarks <br />Nnte: Original to Customer <br />1 Capy to File <br />1 Copy to InsPectar <br />� <br />I he untlersignetl owner hereby agrees to hold and <br />savo harmless the City of Everett frem any and all <br />daims tor damages that may arise because of installa� <br />tion and mainrenance of the improvement hereto <br />ap� lied tor and further ayrees to remove same upon <br />notice from the City and to rep�ace pu6lic property <br />damageo there6y. <br />Signatum of Aoplicant <br />Address <br />Telephone Number <br />�� ~ ��- <br />Fee <br />Dept. Approva� �� <br />Engineepr�=I/- /� ,/ • ,p <br />Waler //• ✓ce,n/JC-I' /`7L� Y a �'�'BvJ. <br />s«��c � ., A <br />r.. �=r.�.,s— <br />Traffic � - � _ �' � �� f- <br />Planniny- " � - ;�-��7—�; <br />.se w=_�N-�.. ,o f., ~,a-�'ad PA� iY�7`eai <br />—� <br />� 11 `� �+ 0 Approved hy�"�` � � [ <br />`_ __'i,. _l'c=y�� l;il��� <br />Gate App�oved ��� <br />