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everett APPLICATION FOR RIGHT-OF-WQY US[ PERMIT <br /> e �� �5 � � <br /> CITY ENGINEERS <br /> EVERETT, WqSH�NG70N � j / <br /> PERMIT NO.�_��� <br /> The Undersigred �,-�.I/ i- K •��.r ,_r F � � <br /> --'------�—_. <br /> � Hereby applies for permission m '� � � � <br /> ;� �.l,�i •.- —4.J �'�' �.J `' � /� . <br /> ' ' � ' ' r � ( <br /> At the following loca[ian ���r,�� 1 ���> , _ <br /> . J, :�,:" V✓ <br /> SKETCH -- —�_ <br /> � (Work to be done) <br /> SC� �i :-1� r+ _ �) <br /> � <br /> I <br /> � <br /> DRIVEWAY SECTION <br /> NO SCALE The undersiSoed owner hereby agrees to hold and <br /> i f'----- ---___ __� save harmless the City of Everett from any and all <br /> � claims for damages that may,arise because of installa� ; <br /> ;I" uP tion and maintenance of�(he�improvement hereto <br /> I I 30" �-- 30 �lied-fo d further� ees to remove same upon <br /> �� �'� notice from he Ci � <br /> N lace public properry <br /> I damaged ereby. �, <br /> ' � ture of Apph ant � <br /> i --- � <br /> � COPY OF THIS APpLICA710N T0� � � -. <br /> .� BE POSTED ON JOBSITE. � Address <br /> � � CALL ENGINEERIh�G UEPT. 259-C;;1 ! ' Telephone Numher ' <br /> � � 24 FfOUfS i;EFOf�i ..iii�15T61 C710A�j ��. <br /> � -� - � _. - -- � _ Date j <br /> CHECK LIST ' <br /> � Water Valve F� 7 S� , —' — <br /> Drainage ep pprovals <br /> �, Curb&Gutter 9 ���1 <br /> Sidewalk En ineers -� <br /> �_ <br /> Water <br /> SVeet <br /> ; Inspector'sSignature Communications � <br /> Traffic <br /> '� a[-6. e --�--- Planning — �. <br /> Hemarks — <br /> Note: Oliginal to Customer — � <br /> 1 Copy to File '! ( !n� <br /> 1 Copy to Inspector 1"'� `�� " <br /> Approved by � <br /> Date Approved <br />