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APPLICATION FOR RIGHT-OF-WAY USE F'ERMIT <br />Cvnretl <br />�� , . <br />CITY ENt�INEERS <br />EVERETi,WASHINGTON <br />The Urdersigned <br />At �he foliowing location <br />!Work to be done) <br />DRIVEWAV SECTION <br />NO SCALE� <br />� 2 � ~I <br />I'� LIP <br />�3_0.+-_.� _`_L�___ _�30��1 <br />� �o <br />COPY OF THIS APPLICATION TO <br />. BC POSTED ON JOBSITE. II <br />�ALL ENGIP�ECRING DEPT.759-&:1 t'�, <br />�,n` � <br />ir.s r�EFor�E car�srr�ucrio!: <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />._.`'�,�/ � "��� - ��' � " ._ — <br />Inspector's Sic�nature <br />—NEIn/ C'./�/b'C;'��'_ <br />!rl/Ni/�'IUN7 G " % <br />4� `:1. �; <br />�'� - ' . ��. � � <br />.. '�'-r�, - _, , <br />Remarks , . .. I'��.i; �. .,., � , <br />Note: Ori9inal io Customer <br />t CaPy ro File �Q't79 <br />1 Copy to �nsper.tor <br />J ..� ; .,.i <br />7� � � <br />PERMIT N0. <br />-[=/�GL OF CX/.S i7N�- <br />/�RV�M � /`1 T <br />The undersigned owner hereby agrees to hold and <br />save narmless the Ciry of Everett from any and all <br />claims for dama9es that may arise because ot in;talla� <br />tion and maintenance of the improvement hmeto <br />applied for and turther agrees to remove seme upon <br />notice from the Ciry and to replace public property <br />da ged thereby, <br />i ��- <br />�pnature o Applicant <br />." ��,— ��T.. r��'y� F //uv� -a� <br />Address <br />''�-Y-''S�ov a.,�o..E.2�-8�s/9 <br />Telnphone Number <br />/i' ��.:.� � fY�'r— <br />Dat�rv � ��Z(j� � � <br />Fee <br />Dept. Approvals <br />Engineers �C_� ��'.Cin.CI��C.c- ZL %r <br />Water 'y 7 <br />Street�___;i._,,,,,_ • <br />Ccmmunicatipn�-. ��-� - � — <br />Traffic S �� .� !�� �;i.,� <br />Planning � � . i ' ,� � L� �` <br />Approved by <br />Date Appioved ,j � ���� <br />