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everctt <br />� <br />CITY ENGINEERS <br />EVERETT,WASHINGT6N <br />APPLICATION FOR RII:HT-OF•WAY JSE PERMIT <br />10848 <br />PERMIT N0.__'? ���_ <br />The Undersigned _._'.�.� �!:_!�.� � ' - __ <br />Hereby ap�dies for pennission to i'!i�/S-1 •i .�� ,-� a 7 7' r�5,-.,,� i_� ��.,r ; _ <br />/ <br />Atthefollovringloca[ion�_;�_t�/ ��.� � �jt_r/'":�t �/ L• i�i,�.�= ���1�=':`�'�...-� <br />SKFTCH <br />(Work to be donr.) <br />ORIVEWAY SECTION <br />NO SCALE <br />r - � <br />�i„ �iv �� <br />L.3� �' _ --�._�- - - - � -�.3� "� <br />�COPYOf TfIIc;APPLP.:i1IlOf; IU <br />iOE FOSTCU ON JO[iSl I E. <br />�CALL ENGIN[[RING DFPT.259�8811 <br />I <br />.�1 HCIURS L'G��)fiF COh�rl I HU::IIpN � <br />CHECK LIST <br />Water Valve <br />Draina9e <br />Oirb & Gutter <br />Sidewalk <br />Inspector's Signature <br />i1GC /fl�it ca.� <br />--- ----. _.... _ _ .. . . - - ---- <br />a�e <br />Remarks <br />Notc: Original to Gistomcr <br />, ���„Y �o F,�� 1. � �j /t $ <br />1 Cepy to In�pnr.tai <br />�/'�_ %-� % i:�Lli ��> <br />The undersigned owner hereby a9rer.s to hold and <br />save harmless the Ciry of Everett from any and all <br />claims (or dama!�es that may arise because of installa� <br />tion and maintenance of Ihe improvement hereto <br />�q�plied for and further ayrees to remove same upon <br />notice from the City and to replace public property <br />damagGd tliera� f <br />�// �%� �.��// �.r� -7 <br />gn51 ature f Ad pplicant �--- <br />Addres�--� �� <br />�� 5�.? - O U i 5 �v. i.�/ <br />Telepho e Number <br />�� � � <br />Dat <br />Fee <br />Dept. Approvals <br />Engineers_ _ <br />Water <br />Street___ ___ <br />Ccmmunications ___ <br />Traffic___,__ _ <br />Plannina <br />APProved by <br />Date ApproveJ <br />