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evere„ <br />eJ <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />APPLICATION FOR RI�HT-OF•WAY USE PERMIT <br />� • � i <br />PERMIT N0. %/— zS <br />TheUndersigned� ,,>,_�s l-i,�,��ii' P���r� � �T <br />Hereby applies for permission to I'er, st,-,.:. r ��n �,r; i „i ,�� l / i, � �r �� .� � � � � �� �� ...r � � <br />.�i . .... ,. <br />At the following <br />SKETCH <br />(Work to be done) <br />Sf�: <br />ORIVEWAY SECTION - <br />NO SCALE <br />� � <br />I" LIP <br />30'�_ __ ., _ _ I . _30" I <br />—r �I <br />COF'Y OF THIS �>PPLICATION TO <br />BE POSTED ON J06SITE. �I <br />CALL E�GINEERING DEPT. 259�Si; I 1 i <br />24 fiOURS BEFORE CONSTRUCTIOf�! i <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Sic�nature <br />Note: Ori9inal [o Customet <br />, coPv �o r-�i� 1 Q�� 6 <br />1 Copy to Inspector <br />l � ,' i'�_; /t: 0 <br />i' . ' <br />".t%��� ��� :�� <br />��"�'7% <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 of install;,� <br />tion and maintenance of the impro�ment-hereto � <br />applied for and further agrees to remove same upen <br />notice from the Ciry and to replace public properry <br />damage6 thereby. <br />�.�,�- J/ ..� �� <br />S�gnaturc of Applicant <br />� /,n.Y-��% ���J�✓'Y��/r <br />Address <br />S%- 7G S 7 <br />Teleph ne Number <br />/- � 7-j7 <br />Date <br />2 � � O v �� �0� '��j� <br />Fee <br />Planning_ <br />C.•=_..., [-�i,t,,..� .7 . � �.�. �• �. -��5/ <br />� �' <br />Approved by <br />Date Approved <br />