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r� erctt <br />e <br />CITY ENGINEERS <br />EVERETT,WAShINGTON <br />Af�PLICATION FOR RIGHT•OF•W.1Y USE PERMIT <br />.��025 <br />F'ERMIT NO.�Y' — I "f"O <br />The Undersigned � �� �/ Y � .L� C_l /�/ <br />Hereby applies for peimission [o W f L7.�N ��r�it/C � k T� � R 1 V� W/4 y I� t=i", <br />At [he following Iocation (i �oQJ'r���,i �{% j�$�. _ _ <br />SKETCH <br />(Work to be donel <br />r <br />� <br />� <br />DRIVEWAY SEC7i0N <br />NO SCAt/E <br />f �Z" �'i <br />�I'� LIP � <br />, <br />30�__._.__—_—.____..— 1 30'.� <br />T — <br />COPY UF TI115 ili'PLICA i IOfJ l O ' <br />k7E POSTrD GfJ JOBSITC. <br />CALL ENGINEERING DEPT. 259-8817 <br />_4 HOURS [3[f-(lR[ C(lNSiRUCTIl1N. <br />CHECK LIST <br />Water Vaive <br />Drainage v <br />Curb & Gutter <br />Sidewalk <br />L;� .�t O'�� <br />I nspector's Signa W re <br />� <br />flemarks <br />Note: Original to Customer <br />,�o,���oF��� ipn25 <br />7 Copy ro Inspector <br />w� ar,t <br />'�IPE <br />i- <br />J <br />�L <br />�_U <br />L <br />PQ <br />�X�ST� N v <br />cv ¢.g <br />The undersigned oH�ner hereby agrees to hold and <br />save harmless the City of Everett from any and all <br />claims for damages that may arise because ot installa� <br />tion and maintenance of the improvement hereto <br />applied for and further agrees to remove same upon <br />notice 6�om the Ciry and to replace publir, property <br />damaged ereby. <br />Sig u/re� o ApP � a t' ��� <br />,�� —�L(1 d-1= �E=(�.�- <br />� Ad ress <br />4 � / — <br />/JL (�� �0� Telephone umbe <br />Y W' � �. <br />•J� �'�.�U Dat 0O — <br />� ---- �P 7/��a/_-,� v <br />Fec r`�7��:8'x358z5 <br />Dept. Approt•als <br />nPn�o�ed �y�y � �j�,..,.c� <br />�fan7 <br />� yDatr. Approved �y — � = % <br />