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.�;. <br />`�' , , ,.t;.� <br />cvr.ct� <br />� �.'`.J <br />) <br />��:.i� <br />CITY GNGINEERS <br />LVGR[Tl". Wl1SFII�GTON <br />TTm Underigned ._ <br />HereLy applir,s for permission to <br />A[ the tollowing location <br />IWork to be done) <br />r�PPLICi\TIOiI FOR f11GN I'-OF-Nll\v u:;e ��r_�rnrr <br />ORIVEWA'/ SECTION <br />t10 SCAIE <br />� —� <br />I" LIP _� <br />I 30 I _____ I 30" I <br />�� �t'--- � ' _�1' '1 <br />CGPY Of- 7HIS APPLICl;TICN TO <br />BE POSTID OPJ J06SITE. <br />CALL ENGWEERING DEPT. 259�8817 <br />24 HOURS f3f1=0R[ CONSTRUCTION <br />CHECK LIST <br />lNater Valve <br />�rainage <br />Curb & Gut[cr <br />Sidrwalk <br />nspector's Signa W re <br />�Ste <br />I;emarks <br />PGli�vilT N0. <br />� <br />The undersigned o�vner hereby a9rees to hold and <br />savc harmless the Ciry of Evcrett froin any and all <br />claims for damages that may arise because uf installa- <br />tion and maintenance o( the improvement herero <br />applied for and further a9rees to remove same upon <br />no�iea�rom Ihe City and to replace public properry <br />dan�e therel�y./,� � � �� <br />£-v�ti% �C Lwv�+�� _ <br />Si9nature of Applicant � <br />�%:'.�� f ��,i�r�la/T.z.�! Lal.e-i <br />Address <br />��5 J—?7ejv <br />Tclephone Number <br />/— /� —7� _ <br />Ddte <br />CC�)t. �;7�)fOv215 <br />Sueet —' --------- <br />Tra(fic_.__ <br />Planning <br />Nnle: Or'��nal to Cu;[omer <br />, ����,. t�, �-,�� �;. � C � 9 -- <br />1 Copy to Im.per,tur � ApPfoved by <br />' ___.______ ____ .______. __ _—__' ._ __- <br />D.i��: Ai;��rov�:�l <br />