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evcretl <br />�I <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />T!•" Ur,de,signed P.,�_. <br />Hercby applies for permission tn <br />Ac the following <br />(Work to be done� <br />DRIVEWqy $EC710N <br />NO SCALE <br />r--_ _.___ __ _— - - � <br />� 11" LIP / <br />�30-.{..—____—._._—__.__-. _. I 30" I <br />��o �I <br />. COPY U�� TI-II;; ,API';.IC,ATIGfJ Tp <br />��'�i= �'057ED ON JOBSI�iE. <br />. �. ALL EfJGWEERIfdG p�pT ��9_��� � ; <br />�. ���ou�1;11�:.or;;: � <br />. 'i;f1,UL�lUf9i <br />CHECK LIST <br />Water Valve <br />Dr�inaye <br />Ciub & Gutter <br />Sidetvalk <br />Signature <br />Remarks <br />Note: Original to Customer <br />7 CoPY to Fiic '� �� .'-� � j i <br />1 CoPY �o In_;.,�tnr ._ . � � <br />APPLICATION FOR RIrNr.��_�.,.....__ <br />""�`'T v�t NERMIT <br />�F'-' N ; %.-� cN: o <br />:L:iuSU <br />PERMITN0._ �',_ ��_ <br />� <br />�_ <br />The undersigned owner herr.by agrees to hold and <br />save harmless the City of Everett from any and all <br />claim� ':r damages that may arise because of installa� <br />tion aiid maintena.ice of tlie improvement hereto <br />�pplind for and further a9rees (o remove same upon <br />noticc from the City and to replace public ro <br />da�e �� v/ P Perty <br />/ <br />ig�nature of pplicant� <br />Add' re s) �v �� � % <br />�S�-/ .SD D <br />Telephone Number <br />—�n `�i� %� <br />Date `"r-- <br />n�, /� � � <br />Fee '�'�'----1--� � ' '� �—} <br />� -f- Z�rf( <br />DeFt• A provals � <br />Engineers � ���`�% � <br />Water <br />Ccm <br />TrnN <br />APProved by <br />Date Ar.,.��,.,� <br />