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everett <br />� <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />10478���; � <br />��� <br />PERMIT N0._! g�� ��� <br />The Undersigned L E G H, I.��: n �� � i'I �( �F <br />Hereby applies for permission to C c n z 1' r<< cf G 2 S' A s �/� r, / f `��w o-, <br />C: f.. �� � n f r 1�., <br />At the following <br />(Work to be done) <br />�A� <br />� ' � /// �\ <br />� <br />i.�� <br />' I <br />- e <br />�_ f <br />^ �n��r,„q <br />,.ti roC h, ��W � � � <br />� ' � <br />\ q L <br />t � � � � � f � <br />\ " L�,y,,r <br />. c,� <br />�� �'c ', � c1li %��� .`, j�'1 \\.v'��,�.�W� �� <br />�\ �. \ ` / j J {. � <br />DRIVEWAY SECTION <br />�— 2G,. NO SCA�E-- � <br />� <br />�� +I�� LIP � <br />30'�—. _—__—___�.3� <br />COPY OF THIS APPLICATION TO � <br />BE POSTED ON JOBSITE. <br />� CALL ENGWL=ERING DEPT.259-881 I I <br />� 2�7 IfOURS BFGOR!� CONSTRUCTIOfVI <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gut[er <br />Sidewalk <br />I nspector's S ignatu re <br />Remarks <br />Note: Original to Customer <br />1 CopY to File <br />1 Copy to Inspector <br />N�.JJ � <br />i ���' <br />�U <br />Ho �cr. /F <br />���..,h� <br />s/z s h E, <br />��,,,� y <br />d r.. • <br />���53 �� <br />r , \ <br />~�--� �ti^���� ' r� � <br />i jDG• u.. 'j�L <br />„� �� / <br />/ � <br />� ��I ' <br />. % h C � � ; <br />� i <br />�� � l-'� � •�'t � � . it'°'� 1 � .r <br />��,,_;. <br />� �� <br />� ,i <br />A� � � � � i <br />The undersigned owner hereby agrees ro hold and <br />save harmless the City ot Everett from any and all <br />claims for damayes that may arise because of installa� <br />tion and maintenance of the improvement hereto <br />applied for and further agrees !o remove same upon <br />notice from the Ciry xnd to rep�ace public property <br />damage� thereby. <br />' O <br />�'��L�),�,? ,��- <br />Signamre of Appli an� <br />f' '� � U � � _.�� .c �-- .�-//�. <br />Address <br />'' 3S3-3SS3 <br />Tetephone Number <br />�-l`r-7G �,�j <br />Date � `�. iU, c �' �G�' :O/(,/-7 <br />Fee � `� <br />De t. ppr v I� / <br />� � /6 <br />Enginee <br />Water��,���,.yl,_,�1�(i, o ��� <br />Street ��'�`-:� �� <br />Communications � L"� <br />/�� <br />Traffic ' �-, ' ��. � <br />Piannina l: �:. l �� ( lc..� �S.v/�/7� <br />1;=:E+p-1, , i� . C ,� � -7-i'� F'•.� <br />�n��( AP—p�cby �, /_� <br />Iti �L� <br />Date Aporoved <br />