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cvcrcll <br />� <br />CITY ENGINEERS <br />EVERETT, WASHINGTON ___ <br />The Undersigned <br />ission to <br />At the following location <br />(Work to be done) <br />APPIICATION FOR RIGHT-OF-WAY USE PERMIT <br />� � <br />� f. � <br />v , i <br />SUNSt T <br />Ex�s nNc D b� <br />Cr�T caR�inG To BE <br />REPV I CED <br />� - -Z <br />ND SC/-�L` <br />DRIVEWAY SECTION <br />(. NO SCALE <br />I ���—._____.�� <br />+I•� LIP / I <br />�30`�__._- /�-'___—�"1'30,� <br />: OPY OF THIS APPUCATION 10 <br />:tl; POSTED ON JOBSiTE. <br />.::u_I_ !S:'JGIP1fERIidGDEPL2hD�flc1�� <br />� cr i ur,i_ co�as � �3u�:rion:J <br />CHECK LIST <br />�Vater Valve <br />Diainage <br />Curb & Gutter <br />Sidewalk <br />I _,�� ��, <br />� Z � i i <br />�i_, <br />Inspector'S S�gnature <br />Remarks <br />Ll)NE <br />5/04 <br />c} �� �., . <br />�.o1�i <br />PERMIT NO. 75 7 � <br />� <br />13. 5' <br />� <br />-NFW C1JlVCRETE <br />L7ZlVEW/�Y <br />The undersigned owner hereby agrees to hnld and <br />save harmless the Ciry of Everett from any and all <br />claims (or dama9es that may arise because of installa� <br />tion and maintenance of the improvement herero <br />applied tof ahd further agrees to Jemove same upon <br />notice frbm the Ciry and �ep�5ce�publiCproperty <br />damage ,thoreby. / I/� i �' �J <br />V' �i... l/ �.���., �%��^-�_ <br />�i:� <br />L� <br />`=v'.,t.-ri! — ZSZ-55�u <br />Telephone Number <br />Date <br />7. ,S�O � �-a�-7 r,(�ii <br />I ee <br />D t. A provals <br />Engineers`_��" ""'"`„"'1''�/ .J�'� 7S <br />Water �� <br />Ccmmunications "d''�-�•- - <br />Plann <br />Notc: Original to Customer <br />1 Conv lo F��� 10191 <br />1 CopY tu Inspector Approved b�� Q ,� �, ,;_�'7 <br />��! �'�_;�; Cn�i-!� (�,� .. �—/-} <br />i <br />DatrApproved �� <br />