Laserfiche WebLink
� �YU <br />� <br />CITY ENCINEERS <br />EVEfiETT. WASHINGTOIJ <br />Thc Undersigned _ <br />Hereby applies for permission to <br />At the tollowing <br />(Work m be Aone) <br />� <br />APPLICATIOM FOR RIGHT-OF-WAY USE PERMIT <br />��'1L�8 ! <br />DRIVEWAY SECTION <br />NO SCALE <br />— --- —. _ _ __� <br />� j I•' LIP i� <br />�30' 30 � <br />_�.___—.-___ _- _ . __ <br />-- ---_ _- . __, <br />I COPY OF THIS APPLICATION TO , <br />j BE PD;TED ON JOBSITE. , <br />�� C,^.LL ENGINEERING DEPT. 259�8811 � <br />'�l HOURS 6EFORE CONSI I'.U•^.T!Oid I <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & G �tter <br />Sidewalk <br />Note: Griginal to Ci jstomer <br />iCopvtoFilc ��,��� <br />1 Copy ro Inspr.ctor <br />�. . ��.., .. <br />/ <br />. / � " <br />I��_/i,- I- <br />��� � /,' I , <br />,,;�,- r; <br />PERMITNO. � � --� <br />The undcrsiyned ownen c�reby agrees to hold and <br />save h�rmless the City of EvereC `•om any and all <br />daims tor damages!hat may arise �cause of installa- <br />tion and main±enance of the improvement liereto <br />applied for and further a9rees to r.move same upon <br />notice from the City and to replace public praperty <br />damage/d,-yihe b/y„ /� j <br />=i;f' _/r.� "/ / _ <br />Signature of Ap i an��- <br />�' ' ��l � --- <br />Address <br />"t � r_ S-r�n <br />Te ephone Number <br />�� / z— %� <br />Date <br />Dept. Approvals <br />Communications <br />Approved by <br />Dan: Apfrovcu <br />