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p <br />F <br />�ren <br />�� <br />CITY ENGINEERS <br />EVE,4ETT, WASIiINGTON <br />� <br />APPLICl�TION FOR RIGHT-OF-WAY USE PERM4T �;_ <br />1c�J���� <br />_ -; ; <br />reRnniT r�e._ -. <br />TheUndersigned �%i� �—L.��-�-L� '� � <br />Hereby applies ior permission to � �'n� > T-'� -� � � '� � � �� � � �~ � ���� � <br />, ��T <br />At ihe following <br />SKETCH <br />(Work to be done) <br />� <br />/ % _' /7 ' `� <br />DRIVEWAY SECTION <br />NO SCALE-- _ � <br />r --- ,� <br />1 \ +I" lIP <br />4���'7� ----_ --�'i�� � <br />I� COPY OF -CH�S A?PLICATIOi': 7U '� <br />' BE POSTED ON J06SITE. � <br />ICALL FNGINEERING DEPT. 259�9f311 .. <br />..,1 hi �� :..�., i i �.;iJ�-:t IfIUt'l�l(;�i <br />CHECK LIST <br />W2i8f Un�VC <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signawre <br />Remarks <br />Note: Oriyinal to Customer <br />7 Copy to File �_ �i ,�-J �� <br />t conv t� ��Sn���or <br />The undersigned owner hereby agrees to hold and <br />szve harmless the City of Evere[[ from ariy and all <br />claims for demages that may arise because of installa� <br />tion and rnainterance of the improvement hereto <br />applied for and further a9rees to remove same upon <br />notice (rom the City and [o re a��ublic property <br />dama5e(j.jiiereby. j <br />� f — <br />Sig aturr. o Applicant <br />Address <br />� i- > - �..r� — <br />Telephone Number <br />�� ti - 7� <br />oaie <br />/' � — _ — <br />Fee �� '—'�- � <br />�� ��• <br />Dept. ppr yals <br />J ,� <br />En9ineers_ --�--- <br />Water_ _ -- <br />Commu <br />Plann <br />Approved by <br />uate APProvwi <br />