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everett <br />e <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />� <br />APPLICATION FOR RIGHT•OF-WAY USE PERMIT <br />The Undersigned Dc // � F � C` / c.. )- <br />Herebyappliesforpe�missionto Cor�Si�,i�y o 1�' �ts�hc/t v/.y <br />� <br />At the to�lowing location <br />(Work to be done) <br />10462 ��y�� <br />, �/'�„�I �(; <br />�°�( �, <br />, <br />PERMITNO. 7�� ^ �; % <br />� � 4 <br />� 4 � <br />i} <br />I'IV JCnIC <br />�G-�.�.,.w <br />�'- � - 7G <br />DRIVEWAY SECTION <br />NO SCALE <br />F— 2s' —.{ <br />�'� LIP � <br />�'�—��.1.__. --_. —_�1'30'i <br />1'j� <br />COPY�OF THIS P.PPLICATION TO <br />BE YUSl6U UN.;OBSITE. . <br />. CnLL FNGINFLRI�G L>CPT. 25�3-filil I <br />�,''�1 ',�.�i 4;:, dGFORt[ CqNSi RUCTICI: <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />%� <br />Inspec r' Signa re <br />Ir . "I /� <br />ate <br />Remarks <br />Note: Ori9inal to Customer <br />, �o�Y �o F��� 1 n��; 7 <br />1 Copy to Inspector � <br />��L <br />V <br />� <br />� <br />Q <br />2 <br />� <br />O <br />iN <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and all <br />claims for damages that may arise because o( installa- <br />tion anA maintenance of the improvement hereto <br />aUP�icd for d further agrees,�o rem e sarre unon <br />notir.e (ro the,C�'tty and to lalac�}�bii�operty <br />damage her� �' /� /,�j <br />�d�-k'�`7T . /� N <br />Telephone Ncmber <br />J`J., _'i�' ' Q <br />Datc <br />J i % <br />Fee $ i 2 , SZ� �G � � � <br />D t. pprovals <br />[ngineer �� / `S <br />Water er earSc N �'� <br />Street l ' <br />Communications <br />Traf(ic 7��- - !�,� <br />j, /i <br />Planning` ���� �if /% ��i �� - � �7� <br />Sx,.�, -,v.c rG� .�t.. � ,o_ ��.�SIz��7; <br />Approved b .. 5�,� <br />Date�/�pproved � <br />