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everett <br />� <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />The Undersigned � <br />Hereby applies for permission to <br />At the following location <br />(Work to be done) <br />W <br />J <br />� <br />'L <br />� <br />� <br />Z <br />Q <br />Wy <br />V <br />tii� Tn <br />�.�1JL� <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />i���� <br />DRIVEWAY SECTION <br />NO SCALE _� <br />� �9 � — <br />�1" LIP � <br />30 <br />�-30-'�----------�i-- <br />rCOPY OF THIS APPLICATION TU �� <br />�E POSTED ON JOBSITE. <br />. C�"�Li. ENGINEERING DEPT. 259�8811 I <br />I7�; I-fOURS �FFORE CONSTRUCTIOPIi <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />PERMITNO. � �I�S <br />si sr PL. SG✓ <br />30/� <br />S sr y�. 5�J <br />GD� /Z/W <br />',---- �DG�- <br />— //� <br />�)♦r.. <br />� L!�/ <br />. <br />� ��. 1 ) � . -� - �� <br />I nspector's Signatu re ���� <br />�- Lt-�- <br />ate 1 <br />UF' PHUFA�i�.t/"l� <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 hecause of installa� <br />tion and maintenance oT the improvement hereto <br />applied for and further agrees to remove same upon <br />notice from the City and to replace public property <br />dama,�e thereby. <br />° '� i <br />ignature o App icant ' � � <br />�n�� � 4r r� S� <br />1 Ad ress E— U���� <br />�,ti� ���- ,�/� <br />Telephone umber <br />G . Dat �Sp � �% � f�ZO—%� <br />u'V � � Fee r <br />I' Cl% � <br />Dept. Approvals <br />Note: Original to Customer � � � � � _ <br />1 CopY to File ApProved by � /�/ <br />1 Copy ro Inspector tfT�� ���=-��`/ <br />7 �. <br />Dace Approved <br />