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I�!- 1 f:'l'�i <br />� <br />CITy ENGINEERS <br />EVERETT, WqSHiNGiON <br />APPL';;q fION FOR RIGFIT-nc_LNM P'v'�L �EFlfJIIT <br />The Undersigned '' <br />--_ •_' <br />I-%e�eby applies for permission t�� <br />A tt h �� fnll -- .^��_ <br />g location�_ --,_ , <br />(Wcrk tn be done) <br />DRIVFWqy SEC7IGA <br />NO SCALE <br />� ___._._ —� _ <br />—��_�__ � <br />���_�_IP —�� <br />�3�� � �30'� <br />' - � -- ��--- <br />�=Uf'y OF fl-li� �APFI_C';A11Ui�1 TQ <br />�t FO�TED p,y J013S1"iF. <br />�kLL ENGINEERING D � <br />2<I HO EP7. 259�i:r, i �� <br />_ U�S B[FORE fOfd�; 7� ,Urilr�;,�; <br />CHFCKLIST ... .-� � . .... . <br />L7ate• Valve <br />Dram�ge <br />� Curb 8� Gutrer <br />Sidewalk <br />; i, . . <br />. �.� <br />I�1 ctol s i, ature ���-- <br />Date _. // � f��__ <br />( <br />Rem�— <br />Note: Oriyinal to Customer <br />1 CoPV to Filr. ; } --��.., ._ <br />1 CopV to Inspector . . .. , . <br />'� l.1 ( � �. <br />u <br />rtRM17N0.,�_,_ : <br />—�- <br />�-- -- <br />%i -- <br />—� _. <br />The undersigneJ oerner he���y ayrees to hold and <br />save harmless the Ciry o{ Evere;t trom any and al� <br />claims for damage; that may arise because of installa� <br />�'°0 ��d maintenance of the improvement hereto <br />�PP�ied for and further agrees to remove same upon <br />notice from the City and to replace public property <br />damaged thereby. , � - <br />Sign�e of APPlics.�t --�--�—_� <br />Addre,�� �--> . _. . <br />Telephone Nu�n6er <br />na,o �— <br />,' I <br />Dept. An�r,,,,�;� <br />Engir,eers_� �, <br />'Nater -'�- <br />c..-- --� — <br />Communications�_— �— <br />Traffic --� <br />Planning�—���— <br />� <br />_ �_ <br />�appruved hy <br />Daic iHPprnv�,.i <br />�— <br />