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evcrett <br />� <br />CITY ENGINEERS <br />CVtHt7I, WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />PERMIT N <br />The Undersigned ' � , '- �_, .. �., 1 '' . • , . - <br />,�—�— !_ ,.,. <br />Hereby applies for permission to I� j'� ? - - <br />ll <}-� t �'I 141-' V„/" ( <br />At the folluwing location � <br />(WorL to be done) <br />�'T ''i1L :.� <br />� -:11 I : � , �... �j L f F� � <br />�' lA1V-';�n, <br />�1��ji( —_..__ <br />�� , .� 1- -- <br />DRIVEWAY SECTION <br />� SCALE— - <br />-� <br />I" LIP I <br />I..-3- �-.}._ __—._ _ _—_ _. _'___.�30 I <br />-'1 <br />COPti' OF T!-IIS APPLIC�TION TO � <br />BE POSTED ON JO�SITG. � <br />�� C/�LL Efdi;IPJf_ERING DEPI".2G�J�£i;;i l I <br />.- . � .=%:!!' - f'F PORE COp;STRUCTIOii � <br />CHECK LIST <br />Water Valve <br />Draina9e <br />Curb & Gutter� <br />C{rin�..�IL , • <br />��� <br />Remarks �� <br />Note: Original [c Customer <br />1 Copy to File <br />I Copy to Inspector <br />-� ; r <br />.� � : �. <br />.l � v i ..e <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Evere[t from any and all <br />claims (or damages that may arise because of installa� <br />tio� and maintenance of Ihe improvement hereto <br />apPlied for and further agrees to remove tame upon <br />notice from [he City and to replace public property <br />damagEd Ihernby. ,. �� <br />i <br />:Y- <br />Signature of Applicant � - -- <br />' , <br />Address � - <br />Telephone Number � <br />Fee <br />Dept. Approvals <br />Engincers_ � <br />Wa[erl-('�,,�.I�t:rT.!��:<, . Ijt � /(i <br />—�.�-,-�—�-.L-1��l-f--_ <br />c...,e. . � � . <br />Ccmmunications <br />Planning <br />,- q �_ 1 � , �_�:..,s...fr � 1`�' - �-lC <br />Approved by <br />Dotc Appraved <br />