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everrtt <br />�I <br />CITY ENGINEERS <br />EVERETT, WqSHINGTO�' <br />.. <br />AFPLICATION FOR RIGHT-OF-WAY USE PERMlT ,y <br />J_ � � ( `� �jv`' j�' <br />� �� (r; <br />�zQ' <br />PERMITNO. 7�L- "-�-E=—�'�, <br />Ihe Undersigned __.._ �'�� r n Il� C- 1� �� <br />i <br />Hereby applies for permission to ��, � c t,- � j- -�- � � � �� �� <br />(Work to be done) <br />'t '/ <br />� <br />� 1 <br />' ' �r <br />�i �� <br />i�y i�l <br />i . !� <br />I �'� � <br />�, <br />I� ' <br />� i� <br />;� �e <br />i {� � c � <br />!� �r� <br />� IQ <br />� I� <br />IN <br />i � <br />— 6< <br />I <br />DRIVEWAY SECTIO <br />NO SCALE <br />�-- j7' _—_-- —� <br />� 1�" LIP <br />�30�+–_—_ ____��30 I <br />�I <br />� . ��'r' �OF THIS APPLICAI"IUi•! TO <br />.'�''.� POSTED ON JOBSITE. <br />'...;\;.L'eh;GIA1FERIPiG DEPT.259-Bfilt <br />��o;�,,r, e�:ror;c cu�;srr�ucrioni <br />I C.HECK LIST <br />f Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature - <br />Remarks <br />Note: Original to Customcr <br />1 Copy to -iie 1 n�.� 7 6 <br />1 Cop�� tn Inspnctoi <br />_ . � � J ( ., <br />� h-/i.G /7��, <br />�� ���;. <br />.. � ,. .. <br />ADORESS� <br />9'�` vR s � <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and all <br />claims for damages that may arisu hecause of ir.stalla� <br />tion and maintenance of the improvement herato <br />epplied for and further a9r�es to :emove same upon <br />notice from the Ciry and ro reolace public pruperry <br />d'dmagedithereby. � ' �� <br />� `.� � <br />_�'/_i� �7 , ^�" /r_�`�. i/�-J�_ <br />Signature of Applicsn[ <br />9,1 l� - �,� � � �°�� <br />Address <br />�>>- -�-s�s <br />Tele one Number ' <br />i2'' . ./_.,% i i7� <br />Da[e � <br />�'�G i <br />Fee / __�i�._ ����T %G� <br />i �� �I! <br />..'' ��i' <br />i <br />' �� I <br />� •... <br />