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APPLIGATION FOR RIGHT•OF-WAY USE PERMIT �' <br />everett a„ �I � 9 O �1� � � <br />� ' (� <br />� 7 ���,. <br />CITY ENGINEF.'�S �/ ' - � � � . <br />EVEflETT,WASHINGTON� � PERMIT N0. / � `� <br />The Undersigned __ y '-' � �' `� � — <br />Hereby applies for permission to % � ' -� � � � � f" � <br />_�'"''--, ' _ <br />At the followiny location � � r � � -J`Y� ' j—��� -- _ _ <br />SKETCH <br />(Work to be done) <br />DRIVEWAY SErTION <br />NO SCALE <br />�..- i�' -----i <br />� \ j I�� LIP � <br />F3q" _� _--_—_.}.30 � <br />,— �—_ _ <br />COPY OF TFIIS APPLICNTION TO � <br />�E POSTFD ON J08SITE �, <br />CALL [NGIPJEERING DEPT. 259�II811 I <br />24 HOURS E3EFORE CO�15T;iUCTION'� <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />h�spector's Si9nature , <br />ate <br />Remarks <br />5� "`' � - :-� ,�?/ <br />.�4. h� <br />G: 4. <br />.., i��✓�. . . 'i\:�� <br />az,�;-,,✓f�c �- <br />��� �.�«,�-�r�c; <br />�.<l dc �-1E:^✓' <br />Tl:e undersigned owner hereby agrees to hul•� and <br />save harmless the Ciry of Evereti from any a�d all <br />�/ � claims iordamages that may arise �^cause u1 insta'la- <br />� ,� <br />t�"� tion and maintenance of the improvement hereto <br />` �'� applied for and further ayrees So remove same upon <br />ti� f `�� noiice from the City and to r�eplace public property <br />1 �J,i �,��� r'�� damaged thereby.�} ,.•'' St!/G;/�//�f <br />�, �\ �� r `'� /.- '' ,4.. . k��,n�..f.---- — <br />�N. ��\ � Sig ture of Applicant <br />� � = I?� `� r�/ f' Ll. >.'1/J_,_� ' _ �� > %1) ,1 / � l j '�/� <br />i — <br />t; �; A�dress � � I, J.� i <br />. b y <br />Telephone Numb r <br />�, -3— gi, _���, <br />Date / � <br />//J � � � <br />�� / •J�i� � . / /�r <br />Fee �t ~ <br />e t. A pr val � <br />� Z / <br />Engine� _ �,/ <br />Water 2N %�et �''l�ers�' G'.. .�� <br />_ � <br />Street i��,�,.,_:_:.,�.___— <br />Communi at ;..�,-i,�._._ <br />Traffic � �� �-�ti �'S - � <br />t7 0�- <br />Planning�` /�� � ".. �� � �' <br />CI. i� .. - �Lv�- —�L�`s----�i'�!,§7 ��"v � i�!r$ <br />No[e: Original to Customer n <br />i Copy to File '� n��y Q , � � <br />1 CopY to In;pector APProv� � :/ N,:. ._ �t/G %/ <br />� f �� ��� <br />Da�e pproved � <br />