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everen <br />�e <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />APPLICATION FOR RIGHT•OF•WAY USE PERMIT <br />PERMIT N0. �� <br />TheUndersigned�(�//�a�A/�� 1n/. lAiz()NE,` <br />Here6yappliesforpertnissionto /.�d/JS>?vci F7 /S � SJ�!rttT b�,{ !,'l�ice f.�/c F_x�sriai.� <br />�.►r,' F/ (�i� S/jJ %J (;.'7Nv:� �C.v1 fJ TPIrY I d� fa`ilS�� J� iN <br />At the following loeetion�/J // �% Sr. __ _ <br />(Work ro be dane) <br />SC� /�.vG/�t�J <br />DRIVEWAY SECTION <br />NO SCALE <br />h-- ------� <br />I" LIP <br />F��t'—�--�--- - -- —�T'30�1 <br />COPY Of- THIS nPPLICATION TO I, <br />II BE POSTED ON JOBSITE. I <br />� CALL ENGINE[RING DEPT. ?59 fl�lt i�' <br />� � <br />24 HOUfi� BEfORE CONS1Rt1CTIONi <br />� CHECK LIST <br />We[ar Velve <br />' Drainage <br />, Cwb & Gutter <br />Sidewelk <br />Inspector's S ;neture <br />Remarks <br />Note: Original to Custumer <br />1 Copy to File � n!� R 2 <br />1 Copy to Inspec�ui <br />The undcrsigned owner heraby agrees to hold and <br />save harmless the City o.' Everett from any and all <br />claims (or damages thet may aiise because o! installa• <br />tion and maintenence o! the imprwement he�e[o <br />applied for and further agrees to remove same upon <br />notice trom the City and to replaee public property <br />damaqe he�eby. � <br />7r�i�a-.,� w ��1�,�„t� -- <br />Signeture of Ap�icant <br />�a l 5 7� �'F�fr-�]% <br />Address <br />35"3- 39�� <br />Teqlep_h�one Number <br />oe�-,e�_7SL — <br />�ee —Z_ � . q � <br />nDept. Approvpls <br />Engineers G �r�(���t � — <br />Water <br />Sneet_ <br />Communications <br />Approved by <br />Date Approved <br />