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evercB <br />e <br />CITY ENGINFERS <br />EVERE7T. W�tS�INGTON <br />APPLICATION FQR RIGHT OF-WAY USE PERMIT <br />The Undersioned <br />Hereby z?plies for perrt�ission ro _ <br />-'j,�- <br />At the fo�lowing location __ <br />(Work to be done) <br />r�i•��,� ,.��,�- ... � . �� <br />\� <br />�_. . ._.. .__ � . _' _.. ..' <br />3,� �>,� ;: �.9 -- - _ <br />ORIVEWAY SECTION <br />NO SCALE <br />r _ __- � <br />��'• lIP <br />I 30" I � __- �30"� <br />i'_..�i•.. . <br />i COPY OF THIS APPLIC/+TION TU '�, <br />I BE POSTED ON JOCiSITL. ��. <br />iCALL ENGINEFRING DEPT. 259 HH I 1; <br />� 74 HOURS RH�ORE CONSTRUC�IIONI <br />CHECK LIST <br />Wa�er Valve <br />Drainage <br />Curb & Guttr.� <br />Sidewalk <br />.__---------- - .. .__.... ...___._ <br />Inspector's Sionature <br />Datc—_—_. _ __.___-_.. __ <br />Remaikc <br />PERMI�i NO. <br />The undersigned ownen c�reby a�rcci [o hold and <br />save ha�mless the Gty of Everett from any and all <br />claims for damages ihat may arise because of installa� <br />tion and maintenance of thc improvement here[o <br />applied tor and furthe� agree: io remove same upon <br />notir,e from Ihe City and to rrplace public property <br />Aamaged therehy. <br />------------�--_—._ ------- - <br />S�gnature of ApPlicant <br />Address <br />Telephone Number -- <br />Date --_._--�---- --. <br />Fee --� �---� <br />Dept. Approvals <br />Enginr,ers- --. _ ... .--- - <br />Water <br />Stree[_._____ <br />Comrn�n'cations_ __ <br />TrafFic <br />Planning_ <br />_-- s _— <br />_._. _ _ <br />Approved by � <br />� �,�,_ <br />---_ _ - - --__ � , _. <br />I)elrllp�nuvrd �'_/U-�� 9 <br />