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everen <br />e <br />CITY ENGINEERS <br />EVERETT, WI�SHINGTON <br />The Undersigned �'� l '� <br />Hereby applies for permission to <br />At the following <br />(Work to be done) <br />qpPUCATION FOR RIGHT•OF-WAY' USE PERMiT �� 3� 5 ��� ✓�j; <br />�� j�/;�, <br />_.. ,, <br />PERMIT N0._.�" — <br />/�' <br />�,�i✓sT. r)�,. ��;��)C %r <br />� , ii . <br />,-� � ,-,=, <br />J % / � <br />�, DRIVEWAY SECTION <br />NO SCALE <br />�------- 2/' -�i <br />I" LIP q I <br />' 30" _ — __—�•''-�1 <br />�COPY OF�THIS APPLICATION TO �� <br />BE POSTED OPJ JOBSITE. � <br />CALL ENGWEERINGDEPL 259-SE11I <br />I�q �{p�)�� �.;_EFORECONSTRUCTIONi <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />Remarks <br />Note: Original to Customer 1�,� � 5 <br />1 Copy to File <br />1 Copy m Inspecmr <br />� <br />�2-� <br />�,. <br />i <br />-� / �i� : � `� Y– <br />�/�! � /�iSf�'if/1.% ��(/L"I���11�% <br />J , G"l/. <br />`�F_ ; i 1�; �_ <br />� <br />.'L NI_ !C <br />The undersigned owner nereby agrees to hold and <br />save liarmless the City of Everett from any and all <br />claims for damages that may arise because of installa� <br />tion and maintenance of the improvement hereto <br />appiied for and further Tgrees to remove same upon <br />notice from the City and [o replace public property <br />damaged thereby. ���r`"'7 <br />. i (7. �° . �, ./ _. �ri--�,--... . <br />Signatu e of Applic� �� � �/_ � <br />2 y 3 � i <�r���- <br />Address p <br />� 'g -/1 � - <br />Telephone Num6er <br />Date <br />di� ���� � sl-���, <br />Fee <br />Approved by � � `3�_(E'L12 .. <br />A <br />Da[e Approved <br />