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rr —` r•, rr'ral AF'I't.ICATION' FOR I?it;HT ui WAY USE PERMIT <br />I <br />'A I Y LNGINELFi5 <br />E VERETT, WASHINGIUN <br />The Undersigned-—_, �/?/L,C--- t I, t • !: . <br />Hereby applies for permission to—.i✓✓���,_ /1 �'J ..`.� G. 1 <br />At the following location__.. _..-3_n A- - . Z? CJ T ra S.f'� . _S�c <br />SKLTCH <br />(Work to be done) <br />DRIVEWAY SECTION <br />- NO SCALE <br />If' LIP <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT, 259.8811 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />Hern�rks <br />11129 <br />1.1129 <br />PL'RMIT NO._7- 7.4 L. <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and all <br />claims for damages that may arise because of installa• <br />tion and maintenance of the Improvement hereto <br />applied for and further agrees to remove same upon <br />notice front the City and to replace public property <br />damaged y�,t(hh,.roebbv.!rl�� <br />Signature at App real' ntt <br />A'i'/a' 3.R•1.� S� 9�2�'/ <br />Address <br />35'�-a5ty <br />Telephone Number <br />s // c, b a' <br />Dept. Approvals <br />Engineers <br />Street _-- _ <br />Communications _ <br />Traffic <br />Approved by <br />CUSTOMER Date Approved <br />0 <br />