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everetl <br />APPLICATION FOR RIGHT•OF-WAY U5E PERMIT <br />11098 <br />CITY ENGINEERS , , <br />EVERETT,WASHINGTON PERMITNO. �� _ <br />The Undersigned ��"� ta ? T r- r.i `� � r� 1�' T rUC � <br />i <br />Hereby applies fo� �ormispion to <� i� S�- - �, c T q i<� � J•i7 = /)_ �����=�s� � ,,� �„„ <br />�i:�, , i:,.. � �,� �� • ��, �/�i; � r�� ir /'i»L� . . <br />At the following location "3 2 D l S 2=' V � c+N <br />(Work to be done) <br />DRIVEWAY SECTION <br />NO SCALE <br />� ---- --� <br />I�� LIP <br />I 30" I . ___ I 3o I <br />r---T-- ---------- 'i' '.1 <br />� Ci_i Y(i� TH! � � PPLI�'/�,TIU,-,! TU � <br />� ':ii POSTED ON J06SITE ��. <br />� C�(_L ENGINEERING DEPT.259-BF311 �'� <br />I7=3 H�URS 2EFORECOi�!;TRUt:T19N� <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspec[or's Signature <br />Remarks <br />Note: Original to Customer <br />1 Copy to File <br />1 fopy ro Inspector <br />�,c'-` �'t �7N�rt���J <br />� <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 />tion an�' maintenance of the improvement hereto <br />applied for and further agrees to remove same upon <br />notice trom the City and to replace public property <br />damaged thereby. � <br />���/)dTi�n/� /nn T li✓ <br />Signa�t'u1re of qpplicant �7 / <br />Ni) • %'��7Y �� / �n �� � in�r/ <br />Ad res�c—s'� � � <br />^ry - - � 9nr 9``°a <br />ielephone Number <br />�-/(i -7�; <br />Date I� <br />/C EGF / PT � <br />Fee ��.2 -� b/-7� Z—S� • <br />ept. Appr a <br />Engin � <br />Communications <br />zsa�s — <br />Approvt _ � � <br />r � � %��F <br />Date Approved : . �- �,,(' <br />a.. <br />