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� ever^11 .. <br />� <br />CITY ENGINEERS <br />EVERETT,WqSHINGTON <br />� The Undersigned _ �AV� <br />, Her�.�y appiies for permission to <br />��� At the following <br />! s� <br />; tu <br />APPLI�ATIOiV FOR RI�HT-flF-WAY USE PERMIT <br />101?.9 <br />PERMITNO. ��— � � <br />G <br />I <br />�. DRIVEWAY SECT�ON <br />�. NO SCALF� <br />I � I L �� � <br />30'�I_ — /ll , —�'M3�1 <br />�_ <br />COPY OF THIS APPLICATION�TG � <br />BE POST�D ON JOBSITE. '� <br />CALL CNGINfEflIP1G DEPT. 259�II£317 i <br />P�l HOUl;; F.I_�ORE �OIJSTRUCTION� <br />CHEC— K LIST�� <br />utter <br />i-i�l'(, <br />-i��;,� �� �; <br />!nspec[or's SignaWre <br />.. . ; _/ _ . `� � . ... — <br />Remarks <br />Note: Original to Customer <br />1 Copy to File � O'j �(�' <br />1 C�ny to Inspector <br />I /�'� '"' S/, 5; In � i 'f <br />�/-/AL T �,V <br />EX1S T/P' � <br />'� G :r 7"k Z' COl�K.'RETE <br />�✓R� LED NOLE <br />The undersigned owner hereby agrees to holcl and <br />save harmless the City of Everett tiom ary and all <br />claims for damages tha[ may ar:se because of installa- <br />tion and maintenance of the improvement hereto <br />applied for and further agrees to remove same upon <br />tice from the City and to replace pul•?c,property <br />tdam gead�th�eby., /^� � /I e. <br />u �� <br />1� ��- � .-.�-r`.-k <br />Si ature of piica�.c <br />, 0 • B _ 47,8 <br />Address <br />M u.�,l.�"� � �i'R � �s�` <br />Telephone Number <br />�SS-/1 �S <br />Date <br />7. 5o v� pCQ 3-7 -`� fNI <br />Fee <br />��Appra b <br />Y <br />�' __�«���., j�/;:� <br />D"ate App ove <br />