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everert <br />� <br />CITY" E�GINEERS <br />EVERETT, WA�H�NGTON <br />APPLICATIO . FQ�"� IGH i--F=VVr��IZSE PERM17 <br />��` � ;✓/ O. �"_��C . .1. �. i.� t,; :r <br />� <br />�_ �-� ,, <br />� PERMIT N0._�' ';---'- <br />Tbellndersigned i.;�. ;.+..�. , ,,� �.i,�.-_t <br />Here,by applics for permission to _ . � -- �,� .� � �:� � � - � �� <br />At the following �ocation=7f'""�' �� 7S`% � �l .r ;�s__ -- <br />SKETCH <br />(Worlc to be dor�:) <br />� � �LC/T�. � <br />%f�� �1/6/nJA-c_ ��,q$ <br />/�-G'=�-��G GJi rti �`-i� <br />�RIVEHAY SECTION <br />NO SCALE <br />r- -- ---_ .�, <br />I° Llp � <br />; ;�I ....._�30" I <br />- -'i'�- -------- - -- --�1 <br />�' COPY 01= l�H15:.r,. U��.;C-! IVid "i�;, �- <br />BE POSTEiJ UN .10351-i�L. <br />CALL ENG�NEERII�G DE"T. 259-8f; i i. <br />�4 HOUR� f�.EFO,RE CON;TRUCTIuid� <br />CHECK LIST <br />W�(91 �/3�VC <br />Drainage <br />Curb & Gutter � <br />Sidewalk <br />Inspec[or's Signature <br />iSate � ---- -- <br />fJotc: Original to Customer <br />, ��,,,� ,� F,�f. 1.1_ n u I <br />............._ <br />. �,., .�,,,,,,�.,.,�„ <br />4! vF,�l r'o �sraf-t F',�- <br />�.t./S 72 ric �lu��c./�' <br />i <br />� <br />� <br />, � z'� ��r�', <br />The undcrsigned uv✓ner hereby agmes m hold and <br />save harmless the City of Everett trom an � and aIl <br />claims for damayes that may arise because of installa� <br />[ion and maintenance of the improvement here[o <br />applied for and turther agrees to remove same upon <br />notice from the City and to replace public properry <br />damag�cl �� , <br />/ l � � <br />Si namre of Ap i ant �---- <br />/? n f�„ � ;��� <br />Address <br />_���3-/„ in0 <br />-�elephone Numbcr <br />.:.'� /�- 7� <br />J �J —_ <br />�— <br />Dept. A�iprovals <br />, <br />Engineers_�_. �/,L_i.r_:_ __._--- <br />Street <br />Ccmmunicatior <br />Plan <br />Approved by <br />D;rte Approved — ------ .. _._ _ -. .. <br />