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everetl <br />� <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />1�'45� <br />PERMITNO. � /'� � JD <br />TheUndersigned,h�Oi•i.i[ p �;.,�„_;�i� <br />Hereby applies for permission to _ C�.,nf c rn'r. � T !� '1 S- .a>/�/,� ,J� �� // <br />A[ the following <br />SKETCH <br />(Work to be done) <br />DRIVEWAY SECTION <br />NO 3CALE <br />� --- -� <br />I�� LIP <br />�O'�. . ..... . _— �30-�� .f <br />� - <br />' (=OPY OF i�H�". ��PPL!�:i�Tlu'rs i0 � <br />�'� L'E PUST[D'JiV JOBSIT�. <br />' CALL ENGINEERING DEPT. 259�8f21 I. <br />I za ,iouHs e�FORr_ r.nr,�srr,ur; ior, � <br />CHECK LIST <br />Water Valvt! <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signamre <br />Remarks <br />Note: Original to Customer <br />, �oPY ta F��e 1 Q 8 5 3 <br />1 Copy [o Inspector <br />T �• <br />.'�!%�- /,� �'i �,-��.:'/f:�.7 <br />The undersigned ovmer hereby agrees to hold and <br />save harmless the City of Everett from any and all <br />claims for damages that may arisa because of installa- <br />tion and maintenance of the improvement hereto <br />applied for and further agrees to remove same upon <br />rom the City and to ace public property <br />rdama d thereby - � i <br />Si nature of Applicant <br />��l "', S T� A cJG 5 C. <br />Address/ <br />���L't�L�. LwJ456'� ��Q�1 <br />T�ephone Number <br />�i47C-4435 <br />oace — <br />,, �y rji7 <br />Fee � )-n � <br />� � � De Approvals <br />Enginer,�rs_. <br />Commun <br />Approved by <br />Date Approved <br />/' <br />� <br />