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BVrrnft APPL!CATlnni Fr_.o o����- -- - � y � <br /> . .�...�� �-vr-WAY USE PEFiMIT <br /> U • . �-, . _ <br /> � u � u�� <br /> CITY ENGINEERS �� �J1 <br /> EVERETT, WASHINGTON ' . ,_� <br /> . PEkMITNO. ' / L�_ <br /> The Undersignea �^-�f//l.��l/��� ,� /� /�� / <br /> t,i� i /-�s:'�1�—J,t� C <br /> Hertby applies for permission to r.�, . - <br /> /- �' _ T C �/11.7 . !� U <br /> At the following loca[ion� �jQ Vp, /�— � �1 � <br /> �—��'�E �. � <br /> SKETCH � 3 v ' — <br /> (Work to be done) <br /> DRIVEWAY SECTION <br /> NO SCA�E Tiie undersigned o;^�ncr hereby a�rces;o hold aiid <br /> r"--- ----- _� save harmless the Ciry of Everett trom any and all <br /> �---� claims for damages tliat may arise because of installa� <br /> � \ �� ��P �1 tion and maintenance of the improvemnnt hereto <br /> 30" 30" I applicd (or and turiher agrees to remove same upon <br /> _•�•_____—___._ _ _.__.+�.__.-�i <br /> notice from the City and to replace public properry <br /> damage themb <br /> / J ` <br /> rr7 : <br /> S n8ture of Appu ant%�.�� � <br /> I . . . _ r�--[-C2L__ <br /> �� rr;py OF THIS �jNpLICATIOi�I TO ' �/�-'�Y <br /> A dres—a s �` .�.: <br /> ii[ POS'fED C.^:Jvo�iT�. ' -- .' <br /> � `�.LL E^JGINEERING DEFT. 2Gg-3H11 I ���� ��� <br /> Tcleahone Number - <br /> . .; I;�)U'riti L'EFOIi� COfJSTRUCiIQPII � <br /> - . - . . .. Dat�—_���7 _ <br /> CHECK LIST � �� ,� . <br /> Water Valve Fee -j � tiz' : — �� <br /> - � � i <br /> Drainage Dept. Approvals <br /> Curh �:(,J:tC� —I � <br /> Sidewalk_ �J Engineers `'� �%, � ='i�,,._ - . <br /> W3I^f <br /> $IfCQ( <br /> _—.__. _—.—._ _ __ _ . <br /> Ins��ecroi's Signature � �----- - �- Cemmunica[ions � <br /> Traffic <br /> Planning <br /> Date— -- <br /> Remarks —�— <br /> Note: Original to Customer <br /> , c<�ny io F�i� � f?q n 5 <br /> 1 Copy ta Inspectar .. ` . <br /> ��PP�o�ed by �, <br /> ^5tcl�Ppiovetl —�— . <br /> - . � ' — __ —M�i� <br />