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everen <br />e <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />The Undersigned / <br />Hereby applies for perm�ssion to <br />; i i. _ <br />< `i:- <br />At the following <br />(Work ta be done) <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />, , ;, <br />DRIVEWP'/ SECTION <br />NO SCALE <br />F----- ---{ <br />I�� LIP <br />�3O'�___—�—__—i•30" I <br />�� <br />_.... __. .--- ---_ . _..---...I <br />CpPY Of- THIS APFLICATION IO <br />', [3E POST[D ON J06SITE. �, <br />�� CALL ENGINEERING DEPT. 259�SII1 ? I� <br />� �A !-IOURS fi[PC4?E ('ODISTRUCTIOfJ �'i <br />� CHECK LIST <br />Water Valve <br />Draina9e <br />Curb & Gutter � <br />Sidewalk <br />nspector's Signature <br />i: <br />�' �----- - — � �.—_l? . <br />";5 � ;�i : v�/ <br />> <br />PERMITNO. " �" � �% <br />Tlie undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and ail <br />claims tor damages that may arise because of installa� <br />tion and main[enance nf the improvement hereto <br />ap�lied for and further ugrees [o remove same upon <br />notice from the Ciry and tqreplace public property <br />damegfd thereby. �'� /f � ' <br />��.1: �,.� � � ���-C�� <br />S�gnBture of plicant <br />/ ; �'�,_ � a ,� r. �,�,� UJ <br />n �e5s _ <br />� r '1 - : i � / .��. <br />Te one Number <br />.l� =,1 - -, _ -7 �% — <br />Date <br />Fee p r " _ <br />Dept. Aporovals <br />�l <br />Engineers %%� r ' "� - <br />/ . <br />6v�rn. .. � � . .. � . . <br />J[fCP[ _ <br />COITI1TIUf11CBi1005 <br />1�i �'+�GL f�s� �NS Planning ` // <br />_�6CT'i J,�/ ,— J o 6 Ce,yPIEY� � <br />�tc <br />�„r,�,. �2"co,vc, /�iPE —<oeKs o.,f- f,�,,.? <br />i✓h�R T S C�_� .S_t< .v,. u <br />Remarks - � �, ����� <br />Note: Original to Customer <br />1 CoPy to File '���� Q �/_-� 7� - <br />i CopY to Inspector Approved by ,- . <br />-� <br />' /-�" <br />Date Approved �� <br />w <br />