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(evcretl <br />�1 <br />CITY ENGIN�cRC; <br />EVERE'iT. N!4SHING�ON <br />APPLICATION FOR (�IGHI'-UF-LNAY USE PERMIT <br />.�. .�. U � J <br />, ;,. <br />PERMIT N0. / �: '_ <br />Ihe Undersigned f..;� � �. ' �P:\ r�, i� 1: i" �;.� _ __ '-.+ i,'r � � �� � __ <br />HerebyappliesTorpermissionm %'T,r,���:� � " :1 ._.._'����_L:_' �-�%�• r — <br />At the following locaticn '��'-i l _� ''-'--� .�� �� �' �� i"� ___ . <br />SKETCH <br />(Work [o be done) <br />DRIVEWAV SECTIO'I <br />NO SCALF <br />� � <br />�_"'_�I" LIP _�� <br />I 30" I �---- I so" ; <br />"i il' i Or i��IS ti1PFl.li:�l �.,ra �IiJ <br />'�` PGSTED ON J6T3SITE . <br />. '._i_ f=.f�ir,ir,r_�=�;irdG DEPT. Z59-f3&11 <br />_ . ,-� �:� f.�f-��i;P. �'. I�ISTRUCTIOt: <br />CHECK LIS'� <br />Water valve <br />Drainuge <br />Curb & Gr:ter i <br />Sidewalk � <br />Inspector's Signature <br />Remarks <br />Notc: Original to Customer <br />1 CopY to File �.� �� �i � <br />; Cupy to Im,pecror <br />7h� undecrsioned ovmer hereby aqrzes :o hold and <br />save harmless the City of Evera[t Trom any and all <br />claims for damages that may arire 6eca�se of instaf a- <br />tion and m�intenance of the improvemen[ hereto <br />appli�td f: � znd turther ag;ees to reTove same upo�i <br />notice irc �:��? City and tu mplace public property <br />damam�: 5yh",r <br />/;:. ,/,7� <br />�- <br />S� 'L�rc o: . ,pU icant ---- <br />%�'__n. /;�n 7( % <br />Address <br />-� �_ � <br />`�e ephone Number <br />i1 —i7�-:'� . _ <br />Date <br />Fee �Y� 7 t-N <br />Dept. Approvals <br />'J <' /` <br />Engineers � ��t,...,—_._—______ _ <br />Street <br />Communications _ <br />F�,ppro�•ed by <br />Date Appi oved <br />