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everett <br />e <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />P.PPLICATION FOR R!GHT-OF-WAY USE PERMIT <br />1C�571 <br />P�RMIT N0. %G� — � f L� <br />The Undersiyned (��1 4 r k I.C/ e h r' r <br />Hereby appiies for permission to < o ns f r i� c"f Z 2 1� A� n h� r� t ��N � 5 <br />At the following locatio� '? OO 9 �/ i T- (� I $ U� <br />SKETCH <br />(Work to be dore) <br />1fL <br />/� � <br />�/� <br />300y <br />,_ _---�\ <br />� <br />� ..,` , \ <br />r� <br />i N - it zt�� �.- �. --{ <br />.� <br />.� z,, s�w.:� .o - <br />� �. rer <br />, __—�'�]._�_ __ <br />—� <br />�rt=T PLACL S W. <br />GRIVEWAY SECTION <br />NO SCALE <br />�+--- 2 �2 I • -- � <br />I'� LIP <br />{-3oy_ T_____ __ —,�-30'�i <br />COPY OF THIS APPLICnTION TO II <br />BE POSTED ON JOBSITE. <br />CALL ENGINEFRING DEPT.259-SII7 t � <br />' 24 I-iGURS �EFORE CONSTRUCTIOiJ� <br />�_ _ . _---- _..- � -- - ----' <br />CHECK LIST <br />Water Valve <br />prainage <br />Curb & Gutter <br />Sidewalk <br />/i <br />�"J 3' .. 2"fLJ ��,l,�G�Y�' <br />Irspectoi s Signature <br />_� , 7 <br />.� `_i / <br />ate <br />Remarks <br />Note: Original tu Customer <br />; C.ony to File '� l� 57'1 <br />1 Capy to Inspectm <br />�7rGwn by <br />_ 'a.P� R�3 r�7L <br />G <br />� <br />j'I "rZ�� <br />/ j1��' '- <br />_ f �L <br />PI� <br />��� <br />The undersigned owner hereby agrees to hold and <br />save harmless thc City of Everett from any and all <br />ciaims for damayes Ihat may arise hecause of installa• <br />tion and maintenance of the improvement here[o <br />applied for and further agrees to remove same upon <br />notice from the City and to replace public prope-ty <br />damaryed th^reby. �� <br />-�_���� <br />Signalure of Applicant/- ' <br />� I.. (l J "� �� � <br />Address <br />-35 s -- � 7i�/ �s�-fs J <br />TeleQpha� e Numb/er <br />'`7`_' 30 / ' � <br />Date � �� G�7�/_ <br />.9�`2/: �G' i <br />Fee � <br />Dept. Approvals %'G�` �-q27 <br />�, En9ineers�� � ?, fl /� �� � <br />Waterli. pi Nieerse�(� <br />i • <br />Street �� <br />Ccmmunir,ations <br />Tr3tfic�,..s��€�am.�-�-- ����/�7V <br />Piannin �r�: � �� <br />9= / — �J /� <br />SE�l•�ar. � ��� �i'_ h s i�SOfi /�J�'p�f'6�:1. <br />, %— <br />Approved by <br />Date App;oved <br />