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. <br />A�PLICATION =0R RIGFIT-OF-INAY USE PERMIT <br />l'V9.C�� I <br />�i <br />CITY ENGI��EFRS <br />EVERETi. WASHINGTON <br />Thn IlnderSionCcl _�S'_[,���z� ' <br />Hereby applies for permission to �� �r:i•J s Y.;'r.'�, r �I � :-1 � ��it.:; � '� i ; !. . .� <br />At the following location �U% 4 �� '_ �?!. . j_ <br />SKETCH <br />(Work [o be done) <br />, .� � . . , 1�-, r <br />DRIVEWAY SECTION <br />NO SCAI.E <br />f`-----' — -- --� <br />I�� LIP __ 1 <br />�30�-_ — � _ _—__- —�30 � <br />CGPY CiF fIiIS APi'I_ICA�I IOPI TO <br />f3E POSTED OM JOBSITE. <br />Cl�LL [NGIhEERING DEPI'. 259-flII11 ; <br />.. .' 10'� !ii5 i:i: f-0f?C. CO1:57R� 4:T!pi�! <br />. .__.. . . . _ . <br />CHECK LIST <br />Wa[er Valve <br />Drainage <br />Curb & fut?er <br />Sidewalk <br />Insp.ector's Signature <br />Rerr.arks <br />Note: Ori9inal to Customer <br />t CoPy to Filc ^7 �� r, n �� <br />1 Copy to Inspector .. <br />-4 f� (1 r') ti <br />.� ��.7L.0 <br />PERMITNO. . .� � - <br />'he undersiyned oa�ner hereby agrees to hold anG <br />save harmle_s t!ie Ciry of Evere:t from any and all <br />claims for dama9es that may srise becau:e of installa� <br />[iun and maintenance of the improvement hereto <br />dpplinV for end further agrees to removu same upon <br />notice frum the Ci;y and to replace pvblic properry <br />damaged thareby. ,p - <br />O <br />��L� � <br />Signaty pe,uf Ap icant�t� ��� <br />�'>! ? � �7�` sr'/i_ �:/:� <br />Address /��pj;�/ �L, �+&i�j�� <br />�ielephonc Number <br />-- `/8s- i��yG <br />Data <br />:'u� S %�i77 <br />Fe�._�-� .C/ ---- <br />; y ..� <br />Dept. A provals <br />� � ?�' <br />En9in�:;;,_ [ �Ls�.i',+ _ <br />1��.:'r <br />Str€.:; <br />Approved by <br />UUte Approved <br />