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�eren <br />� <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />Thr Undersiyned _�_,____ <br />F!scbY.'�ppliesfm permis;inn [o <br />A; rhn follovin� location <br />SKETCH <br />IWork to be done) <br />� <br />APPLICATiOPJ �C,^, R;GHT•UF-WAY USE PERMIT <br />I'tHMIT <br />_ <br />' _ � - -- <br />•':� , .. . _ _ .. ,. . - <br />1 ' .� `1 � /ili,f- � <br />�,��` <br />�� , <br />!�%. <br />l . -- . �...- . <br />i <br />DRIVEWAY SEC710N <br />NO SCALE <br />r - �J -- -� <br />� jl" LIP <br />`.3�.�„__ ___----._�3Q" I <br />i —..� <br />. 1,. _. , ____ <br />I COPY OF iHIS APPLIC�TION TO � <br />I 13E POSTED ON JOBSITE. ��, <br />; CALL ENGIIVEERING DEPT. 259�8A71 ! <br />� Z:; ii�!� if'.E [?rI-ORE COP!STI?UCTICid � <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />—�f-G7'Y7 _ _ — -- <br />�fspector's Signature <br />te ', �: ; G� -- <br />Remarks <br />Note: Original to Customer <br />7 Copy to File � O�(� G <br />7 Copy to Inspec'.,, <br />�Y� %� _- <br />;. <br />� , <br />; f e <br />The undersigned owner hereby agrces to hold and <br />/�. �� save harmless the City of Everett from any and all <br />��'' I,�." claims for damages that may arise because of install2� <br />.�� � ��,�� �� tion and maintenance of the improvement hcreto <br />�I .','�," appliad for and fur[her agrees to remove sam� u on <br />'- p'���� notic� from the City and to replace public propP ry <br />`t' 1! �I � � dam' aged thereby. <br />� i� �� � � <br />Sighature of�pcan[ <br />� � 9/� > > /s. �a'��' �<- <br />Address - <br />� >> -.� 7.1 � <br />Telephone Number <br />? /> / ^ � <br />Date - <br />�� � �, l _ <br />� i . � ' —�____-- I ! / <br />. . .. . Fee i/i =� �/ <br />I —.— <br />Water_ <br />Ccmmu <br />5.-�..��-, �1 C T.���c� �, �� <br />i —. <br />Approved by � z <br />� _�/ <br />-- _._ , rr.,. �_ �<'' /�, <br />uatc A�,pioved -`'� =- <br />