Laserfiche WebLink
evcrett <br />� <br />�ITY ENGINEEFlS <br />EVEPETT,WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />The Undersigned � � � _ <br />Hereby applies for permission to GG��r . � � -�. � _ %.v =:- .)/v.J <br />At the iollowing location__ � � � <br />SKETCH <br />(Work to be done) <br />/��r, _�G-i rr_:� <br />EX�S-; i✓ <br />/�q i/Et� �=G� � <br />W <br />�n <br />„, <br />DRIVEWAY SECTION <br />NO SCALE <br />r- - -� <br />+I" LIP � <br />L,3��� � _. _ _. ... . . . ...L30 I <br />i <br />,� i�U� f LG O(-1 JU'.�Sil �. . <br />��\I_L ENGINEERWG DEPT.25&8F,'�'� � <br />� lii)'��(;>: f;�FORF CQP;r.�i?UC�f'1;:�: <br />CHECK LIST <br />Watei Valve <br />Draina9e <br />Curb & Gutter <br />Sidewaik <br />'� . <br />•, �� C , = � L_ _ L - <br />Inspec(or s Signature <br />/# /L. <br />nemarK; <br />�btn: Original to Customer <br />7 Copy tn File '� il'� �� <br />� , �.�,i,��.t��� <br />�,-�;���/ <br />. �. <br />���,r1 <br />.._ '.,} .. -� s:: <br />PERMIT N0. <br />NLrti CON�., ��`� <br />CJ <br />Cx� ='"��J:.� <br />�� 'LC. <br />. ;. :.��. wr• �. ,-r , .� — <br />.. <br />=__. �. � , <br />1'he undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and all <br />daims for damages that muy arise because of installa- <br />tion and maintenance of the improvement here.to <br />applied for and further agrees to remove same upon <br />notir.a irom the City and ro replace public properly <br />da� e'+he e� <br />�Si nafure of p icaii� -- <br />_ /�n /�i.. .� � <br />Address <br />/� � �' <br />Telephcae iVumber <br />`�ir-1 -/ sOn <br />Date <br />//_ '� �� ;� �� �� f� i !1 /; � 1.. <br />Fee �' � <br />7' <br />7'j <br />��'�`O,� by �;'' '`�- �� ' - <br />C.(_,� � c.:�:...r_c. G.�-. /� �/('i �� , <br />Datc�Appro'ved , r� . <br />