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everett <br />e <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />The Undersigned <br />Herr.by applies for permission to <br />At the following <br />iWork to oe dune) <br />A <br />�n <br />I <br />io <br />APPLICATION FOR RIGHT-OF•WAY USE PERMIT <br />T - — <br />��- 2' I <br />u � 1 ? S ' <br />� , r „ i I•N' '� <br />�i��:,.�,�,,r �.;.�;,,, <br />. _ �. <br />� ,�., "� <br />, , <br />. .�; , <br />� -- ----,-_-, <br />� � <br />r�.t � <br />-1 � <br />i '=1(;:r'�..—rJ�EXfi71N6 '. <br />I <br />L__'__� <br />DRIVEWAY SEC710N <br />NO SCALE <br />r--- 2 s' �1 <br />�'� LIP <br />�3O.t.. .__._._...___ _—�30'i <br />� COPY��OF THIS i1PPLIC/�llOfJ TO � <br />I, BE PO$`TED ON JOi3S1TG. i <br />�� CAIL ENGINEERING DEPT. 759�t3N11' <br />'.,,�uur�s �3[-ror+�corus,�iiuciiura�� <br />CHECK LIST <br />Watr: Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspeclor's Signature <br />1�ate <br />p. n....n 6� <br />�'`.!� '."_ w 1�: �7G <br />10412�,�;� <br />� <br />���;. <br />PERMITNO. � �- `� � ' <br />� �� <br />I � <br />I � �a � <br />� <br />a," _ <br />t: c: - <br />The undersigned owner hereby agrees to hold and <br />save harmless the Ciry ot Evemtt from any and all <br />claims for damages that may arise because of installa� <br />tion and maintenance of the improvement herero <br />applied for and further agrecs m rnmove same upon <br />notice from the Ciry and to replac:e public properry <br />dam ag/ed. U�ereby. <br />.fi�-o/�,?o%. �<..,,,:! . <br />Signature of Applicant <br />� � <br />Address '� <br />�: _i ::., ? <br />Teiephonc Number <br />4—S-7H "3 � � —?� SI, <br />Date V <br />12'— -a� � �=/. �/-�'-�' <br />Fee <br />De . A roval �/ <br />Enqineer /� T 6 <br />warer o� mv I��ra, eai sc�p —,p � c? <br />� ._ ,., ,. .� r �S[reet � ' -,/ ---- <br />Communicatio � <br />/' " % i <br />Traffir, `� f � _ ��.'S, : <br />Planning � ' 'l. /� . �� �. <br />`ic'• .�'� <br />Note: Original to Cusromcr <br />, �o�y �o F,�� 1(14 � 2 <br />1 Copy to Inspector Approved by �� ��� <br />Datc Approvcd <br />