Laserfiche WebLink
APPLICATION FOR RIGHT•OF-WAY USE PERMIT <br />eyerett 1 0 O 8 9 <br />' � / <br />CITY ENGINEERS 7`^�"sZ� <br />EVERETT, WASHINGTON PERMIT N0. <br />The Undersigned �� �� S 5�'�/ �'�- � �-- S R - <br />��TP��c .o f? t LC�v� T�-- <br />Hereby applies tor permission to C� I I� �-� <br />I�1711 ' �` L�Y>T i..: �;�!`�:�, - ' -- <br />A: the following <br />(Work to be done) <br />rvEw r �' �tic_ <br />n��iv��Y � <br />�x���rwc, �r��- <br />oF ��vca,t�tiT <br />DRIVEWAY SECTION <br />NO �CAJ,E� <br />'i COPY OF THIS APPUCATION TO <br />BE POSTED ON JOBSITE. <br />I C(1L: GNGINLERING DEPT.7!i�RE311 <br />�>�l Il��il�i:l I'i:f-Oi:l- COfv51I�i''.�.IIUf��j <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter � <br />SiAewalk <br />, / <br />��i <br />Inspeclor's SignSW re <br />U;�tc —_ <br />�.- � .��.,. - <br />Remarks <br />Note: Priginal to Customer <br />1 Copy to File <br />7 Copy to Inspector <br />7 <br />fhe undersigned owner hereby agrees ro hold and <br />save harmless the City of Evere[t from any and all <br />claims for damages that may arise because of installa� <br />tion and maintenance of the improvement hereto <br />applied tor and (urther agrees to remove same u��on <br />nutice from the Ciry and to replace public properry <br />i' •1 � c �i � �. <br />Telephone Number , <br />� �C�.1 I Date �,�n �- =i �Z-���� <br />' n / Fce <br />,�����"'� Dept. Approvals <br />✓ <br />10 0 R 9 q��roved by � , <br />r ^' <br />Date App , d <br />�.�c , %�J �4 <br />