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everzn <br />� <br />CITY ENG'IJE:RS <br />EVERETT, WqSffiNGTON <br />,./ <br />The Undersigned <br />Hereby applies foi permission to <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />�'L7 <br />10397 �' %� <br />� <br />� ���E, <br />PERMITNO. �C�" 4� �� <br />Gi .%+�' � c� .: ' - � � . .- _.--- <br />At the foliowing location � 1 f!I — J� J r /!�� `"� y✓. <br />T — <br />(Work to b= done) <br />Fa'/S%. .'�i; y.,;-�'.-- � . _=T� <br />� i �"= %JC � � G'� <br />': � <br />'.4tsF�Ic.— �9vG'n�c.V,— <br />`�ii l - - - <br />GG/�/� ,` fl5:='-,'�:%c j <br />DRIVEWAY SECTION <br />NO SCAL• �J <br />� "'�� — _ I <br />I" LIP _� <br />30" I_____________—_ I 30" I <br />—yi' —.� <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON J06SITE. <br />CALL ENGINEERING DEPT. 259�8811 <br />.24 HOURS EEFOREGON.STRUCTIONI <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />at—�e — <br />Z� <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 installa� <br />'i .�t `� [ion and mai�.tenance of the improvement hereto <br />•� �t {�. `� applied for and further agrees to remove same upon <br />!4�� notice fram the Ciry and to replace public properry <br />� . e <br />W damaged thereby. <br />� . <br />i,}I'' � - —�' --� <br />�� � 1�, Si ature of A�can b <br />('j, il t�, '�.1 % "s�_ �—r ,'ui� .�� - <br />` Address <br />, � Yl .' ,-�-.��1 /d.�� � & � o � <br />Telephone Number <br />.:C S Cl - � � c� o <br />Date <br />� //.:�; : -*�cz-- �/(�, � ,�7� <br />Fee <br />:3,"� <br />:i.: <br />De t. ro al � <br />Enqineers --� <br />Water a At /t r s� < �i � <br />Note: Original to Custome: -- <br />1 Copy to File n'� (� % <br />�_ l� ._ . . . � <br />? Copy to Inspector � ApProved Gy � i ^ <br />����—�� �_ <br />Datc Ap�3iove <br />