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APPLICATION FOR RIGHT-OF-VJAY USE PERMIT <br />evCrett . <br />� <br />CITY ENGINEERS <br />EVERElT, WASHINGTC(J <br />The Undersigned ! ` � <br />Hereby applies for permission to _ <br />At the following <br />�� <br />�f— <br />� ! <br />. . . , _i � <br />� <br />105�14 <br />PEflMIT NO. � ����- � j'=-"' <br />i <br />._ __.___ _. _T_'— ,-� <br />I <br />( _. .__ . . .___.__._ __'_ . __ ' �. <br />- � - � � ---- --�--� ---"� ""-- --- The und�r,igned owner hereby agrees [c hold and <br />DRIVEWAY SECTiON � �_ , <br />nto SC4LE � save harmless [he City oT Everett from anV and all <br />� -- -� --- ---� claims for clamapes that may arise because oF installa� <br />� � � tion and maintenance of the improvement hereto <br />j I„ LIP � applied for and further a9rens to removc same upon <br />i <br />30 �{--_ _..__-_—.}.30 .� notice from the Ciry and to replace public properry <br />�� — ' <br />dar��ed thereb <br />/ r_ .. �';��.Z. <br />Si natur f A plica�t'� [ <br />-� _ ') �( ri ^sj'�- � /l� �:1../� l./if <br />A dress <br />; , � % 7�"%�� <br />Telephone Number <br />�/%_ � / % {L <br />Date <br />C ,� , <br />COPY OP THIS APPLICATION TO , <br />BE POSTED ON JOBSITE. I <br />CALL ENi:Ih1EERING DEP7. 259�88t 1' <br />�24110UR5 6[PORECONSTRUCTION� <br />� <br />CHECK LIST <br />Water Valve <br />Draina9e <br />Cur6 & Gutter <br />Sidewalk <br />� <br />� ���'��-__ <br />Inspector's Signature v <br />.-'�, �� i �� ;� <br />Note: Original to Gusmmer <br />, �oPY to F��� �. �, ,:, n, a <br />1 Copy to Inspector <br />� <br />Dept. Approvals <br />' ; !;�,. <br />Water_ <br />Communications <br />.-. / ; <br />Traftic ,L. .. . . . . �..: : — <br />i <br />Planning ��1 <br />�" , � . i. _,��� .�,�t— <br />n�Pr���d �y <br />Date Approved <br />