Laserfiche WebLink
everetl <br />e <br />CITY ENGINEERS <br />EVERETT. WASHINGTON <br />�..-,�., <br />APPLICATION FOR RIGHT-OF•WAY USE PERMIT <br />1074? <br />PERMITNO.�I�' S 3 <br />The Undersigned / � � � 7 <br />� � n��er�'�� Cv�VE?� iJ Cl�sri��4 <br />Hereby applies for permission to '1 '.J S� / Y� � <br />� . �� � <br />At [he foliowing location 7/ �v S� 3 3�"o +'a�' �Gl �— <br />SKETCH <br />(Work ro be done) <br />DRIVEWAY SECTION <br />NO SCIfLc <br />----_ —J <br />r�— I <br />I" lIP <br />I 30" I � _ �30�� <br />r--�1'�-. _--- - - <br />___--- __ __ - - <br />COPY OF- THIS APPI_ICATIOfJ TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 259�fl811 <br />2-1 HOURS E3EFORE Cl)NSTI�.U(:l IOhJ <br />CHECK LIST <br />W, ter valve <br />Drainage <br />Curb & Gutrer <br />Sidewalk <br />Inspector's Signature <br />Note: Original to Customer <br />, �o,�Y to F,�� a_ n� n� <br />1 Copy to Inspector <br />s�<= ��; ji1;,N;n <br />The undersigned owner hereby agrees to hold xnd <br />save harmless the City oi Evr.rett from any and all <br />claims for damages that may arise because ot installa� <br />tion and maintenance of the improvement hereto <br />applied for and Turther agrees to remove same upon <br />notice (rom the City and to replac lic properry <br />damaged the �' / <br />-�G��L <br />Signa[ure of Applicant <br />�/9a s - � 3'-d �rrn //�oa.sL <br />Address <br />-iSS- � 3�3 <br />Telephone Number <br />3 /� �/� � <br />Date <br />Dept. Ap rovals <br />Engin.e,e�rs ��� � — <br />Water -��t+� ?+�^�?. <br />Street %J� � <br />� <br />Ccmmunications <br />Planning <br />C�-o C T��r. ✓• F, -� � b• <br />�i <br />Approved by <br />Date Approved <br />