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APPLICATION FOR RIGHT-UF-1'�AY USE PEFMIT <br /> � everetl <br /> � 10855 <br /> � CI IY ENGINEERS <br /> EVER[TT, WASHINGTON PERhiITNO. � � . <br /> The UnAersigned <br /> Herebyappliesforpermissionto _ .� � ,, 1 � ��;/�,_ , <br /> At the (cllowing Iceation_ � <br /> SKETCH — <br /> (Wor!c to be donel <br /> ORlvEwu� sECiiON The undersigned owner hereby s�;rees tu hold and � <br /> NO Sr,aLE save harmless the City of Fverett from any and all . <br /> � -� claims for damages thrt miiy arise beceuse of(nstalla� <br /> L� 1 f' Llv ,� tion and maintenance of th,t improvement hereto <br /> I 30" yo' applied for and further agre���to remove some upon <br /> r�—'�'-- ---���--�--- ��� �-�-"�'--� notice from the Ciry and to re���ace pubiic reroperty : <br /> damaged thewby. / <br /> � �m �;..��7l���1 i <br /> Signature of Applicant � � <br /> __ — , ! �—> �� � / -1!�i/, ;, <br /> COPY Of THISAPPLICA�iION l0 A�d�ess I� <br /> BE f'OSTLD ON J013SITE .-' � i; -�G /,j� � (�t ' . , <br /> _ i .; V I <br /> CALLENGINEEHINGDEPT. 259�BHI � � TelephoneNumber _/ <br /> �, � �G � � <br /> 2a nours �r_Foiir cr,rir.irzui:nural oaie — <br /> CHECK LIST � � --- <br /> ,� <br /> Fee r <br /> Water Valve �' <br /> Drainage Dept. ApproV9lf <br /> Curb& Gutte� ' , ' �� .��i'��' � � , , <br /> Sidewalk �' � , � ��. . . Engineers_ IT,����.. — --- <br /> r � <br /> --- Warer <br /> Streel <br /> — — --- <br /> ------------- ----- Communications <br /> Inspector'sSignetwe . � <br /> Traf f ic � <br /> ---- i <br /> Plaanir,g— —. �.. <br /> at�e---- -- -- <br /> Rema:lcc — . � <br /> Note: Ori�7inal to Customm — — -- <br /> 7 CopY to File 'j�R 5 5 — t_ . <br /> 1 Copy to Insp�,ctor Approved by <br /> Date Approved <br />