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everen <br /> APPLICATION FOR RIGHT•OF•WAY USE PERMIT <br /> e �� �1 <br /> CITY ENGINEERS i <br /> EVERETT,WqSHINGTON PERMIT NO.��—i 7� <br /> The Undersigned_�//t i ,�,�';� i,.a c 1n�,L�v ' <br /> Hereby applies for permission to j ri.i Sr�l r/.? /-7 !S' L�sD��— �� i <br /> � <br /> l� <br /> i� - � ! <br /> At the following location_2`�T� �Jit�.> � <br /> SKETCH j <br /> � (Work to be done) � <br /> SFC A ,—r,a����-=o I <br /> � <br /> I <br /> I <br /> ; <br /> j I <br /> I ' <br /> I � <br /> I <br /> i I <br /> � <br /> I <br /> � <br /> iDRIVEWAY SECTION The undersigned owner hereby agrees to hold and <br /> , NO SCaLE _ save harmless the Ciry of Everett from any and all �'� <br /> ; � �� claims for damages that may a�ise because of tnstalla� � <br /> ' /�" uP ---�� tion and maintenance uf the Improvement hereto � <br /> � �p��_ _ . �30,1 , applied for and turther agrees to ramove same upon i <br /> , '� notice from the Ciry and to re lace public properry ' <br /> �. damapa by. % <br /> p � I <br /> I Si nature of Applicant I <br /> �irr, diE[�J ,ci�YG OP .EY tu�i <br /> COPY OF THIS nPPLICATIOK TO � ddress 9��s i <br /> '. BEPOSTEDCNJOBSITE. ' �S�„-�7/ i <br /> . CALLENGWCIIHINGDEPT. 259�HH11i TelephoneNumber j <br /> , �2�1 IIOURS t3Ef-ORE cONS��HUClIONI Date F �� � � <br /> I CHECK LIST PBe � � �� � <br /> ' Watar Valve ' <br /> i <br /> ; Drainage �ept. A�pro�r t . <br /> '� Curb&Gutter Engineers� � <br /> � Sidewalk �� <br /> Water <br /> SVeet � <br /> -- Communications_ I <br /> Inspector's Signature , <br /> Traffic <br /> _ � : <br /> Planning <br /> �te-------- — . <br /> i <br /> emark�s--- <br /> ; Note: Orininal to Customer <br /> � 1 Copy to File 10871 � <br /> 1 Copy to Inspector Approved by ' <br /> Da[e Approved <br />