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APPLICATION FOR RIGHT-OF•WAY USE PERMIT <br /> ' eV� 1��27� <br /> CITY ENGINEERS -, . <br /> EVERETT,WASHINGTON � PERMIT N . �� � " . <br /> The Uncxrsigned���- '� - � <br /> Hereby applies for permission to_,� ��! S '�' � �-d � �� � '� >%� > � �� — <br /> At the following locatwi� ' �� � �. %•����✓� � �---� � <br /> SKETCH <br /> (Work to be done) <br /> , .. . r;�".'?C,a s �.> <br /> � � <br /> � <br /> I <br /> ' i <br /> i <br /> � <br /> DRIVEwAY SECTION The undersigned owner herehy agrees eo hold and I <br /> . NO SCALE save harmless the City of Everett from aay and all , 1 <br /> � �-- ---� daims for damages that may arise because a�5 installa- � � <br /> , �f' LIP � tion and maintenance of the improvement'heretu <br /> applieJ for and further agrees to remove same upon <br /> �� 30" .____.__�.jo� notice from the Ci6y and to�eplace public property . � <br /> dam e t�freby. �I7 p ' <br /> �� '� �Y�'��C.-�cR y _ � <br /> , , Signa�ure of Applicant �j , <br /> ', � �1 !�-e,�J a��Yti �C.._:-w.� ('��70i , � <br /> '� Address � <br /> i CGPY G!- TNIS APPLICATION TO ��, i <br /> f----- 3 3 y 3 <br /> � I BE POSTED ON JDBSITE � I � K� `� � � � <br /> � I CALL ENGINEERING DEPT. 759-881 7 , Telephone Number — <br /> 24 NOURS BEFORE CON,TRUCTION� Date . �-�.� _ � I <br /> c � , <br /> �'�. _ .... _ . .. _. . �� ..- �,� � <br /> ' CHECK LIST Fee I <br /> Water Valve Dept. ApprOvals <br /> Drainage <br /> Curb&Gutter �� ����) �: Engineers ' ' — <br /> Sidewalk Water <br /> 1 <br /> Street <br /> Gommunications _ <br /> Inspector's Signature Traffic <br /> Planning .._ <br /> at-6 e—� -- . <br /> — — � <br /> Remarks <br /> Note: Original to Customer <br /> , �opYto���e 10R?_7 _ <br /> 1 Cooy to Inspector Approved by <br /> Date Approved <br />