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ni�rucnrioN r-or� �ici�r�or-�wnv us� P�r�r�niT <br />10�3� <br />CITY LNGIIJGERS � <br />[VEHLIT, �YASHINGTON PEHMIT NU. 1 �� '� <br />/ <br />The Unclersiyned ��ll1_Y���_��t11~�.r��� — <br />i <br />Herebyapplicsforpermissionto frDl) /O Or C�US//(.O Z'o^/' O/,/ ["[j/L�%�ia� <br />At the (ollowin9 location�,������� �"� <br />(Work to be done) <br />5��= /�7Ti1 cFl�'"J <br />� � Ld Q�l.'[� ��--���t�� ,�X f�� `'-. <br />�k,+� •�te� COz"�,._ L-}-�._LC--� . <br />G " ��a •- � ^% <br />DRIVEWAY SCC?ION <br />NO SCALE� <br />r� j"1 UP <br />30'� � -r30��� <br />COPY OF THIS FlPPUCATION TO <br />QE POSTED ON JOGSiTE. <br />CALL ENGINEERING DC-PT. 2598811 <br />24 HOURS E3EFORE CONSTRUCTION <br />CHECK LIST <br />Wator Valve <br />Draini9e <br />Curb & Gutter <br />Sidcwalk <br />Inspector's Siynaturc <br />ate <br />(lema�ks <br />Notc: Onginal to Custo�ncr <br />, ���,,Y �„ ���� 1� 3 3� <br />1 Cnuv In In�.,�rrtr�r <br />4�� <br />The undcrsigned o�vner hereby agiees to hold and <br />save harmless thc City of Everett �rom any and all <br />claims for damapes that may aris_ because of installa� <br />tion and maintenance of thr �mprovement hereto <br />applied (or and further agrees to remove same upon <br />no ice from the Cit�, and te-r�,�l�cesublic p�o�erlv <br />d� !1x V��r if ,t7— � C_.tJ+t/D � <br />/`�,(.,. , i �_.2��<lG'% ., <br />� ignature of Applicant • <br />,�:--sz 9 .i��P � Y,�. <br />Address <br />3s �—lf O 3 <br />Telephanc Numher <br />Dept. Approvals <br />Communications <br />Annraved 6v <br />