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<br />CI7Y ENGINEERS
<br />EVERETT, WASHI�'GTOPJ
<br />AFPL! �::a.TiOPI FOR RIGHT-OF-W4Y USE PERMIT
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<br />PERMITNO. �=- — �-=
<br />The Undersigned _ � ��7P 57_ ia ,.�_E__. `_
<br />Her:byappliesforpermissionto__�,�,,,r,y.�j� 23• q���h J�Ui {,. .'��.. rn,rl _`
<br />At the foliowing location_�_ S/
<br />£KETCI?
<br />QNork to be dc�ne)
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<br />DRIVEWAY SECTION
<br />NO SCALE
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<br />30" �— —..___—��-30'�I
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<br />COPI OF "iHIS APPLICATION TO ��
<br />I B[ P0� i 1 D GN JOBSITE. '�I
<br />CALL ENGIN[ERING DEPT. 259�88I 1�
<br />24 HGURS BEFORE COfJSI�RUC:TIG'�i �
<br />I CHECK LIST
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<br />Sidev��!1:
<br />Inspector's SignaNre
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<br />Remark, �/�////_ (/vf� f� -�l�F �h�D /�U�
<br />Notc: Oriainal to Cuetomer
<br />1 Copy to File
<br />� 1 Copy to lnspector
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<br />.. �_•..r` / ,.��n:�l�tcd tf .)r-velC�ser
<br />�'"� /C�'P��er�� incl���lr!
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<br />Gr.i7 �. i_:a, �
<br />Th�; unJz;s�gned owner hereby ayrees to hold and
<br />s:;.e harmless the City of Evereri from any and all
<br />clairr^ for damages that may arise because uf installa�
<br />tio�. . d maintenance of the ir,iprovement hereto
<br />applied f or and further agrees tc ��e�nove same upon
<br />notice frum the Ci y ard to repl.�pe pu6lie property
<br />Uan r,ged thereby1 % (�, �
<br />��1� ��'�`i. � ��U�IQ:',
<br />Si�n,ture of(qpplicant. � I(�\
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<br />Addre s
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<br />Telephone Numb�r I � �-
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<br />Date � i � --.�
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<br />Fee —
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<br />Appro �fi', �F" / _
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<br />Da[e Approved
<br />7
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