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everetl <br />� <br />CITY E�dGINEERS <br />EVERETT,WASHINGTON <br />APPUCATION FOR RIGHT-O�=-l4'AY USE PeRiv11T <br />1:101`} <br />PERMIT NO.__�__ _�' <br />The'Jndei�igned _ i� / �"i��! I�` l.U.�� � �_.�'� � �'i- �LZ ___- . _.— .— —____ _ _.-_.. . <br />F!erebY �pFGrs for pennission to _(.G �v � �� � � � T -n 1:.:.---.-.= �--'.-=---:�1-=L--- - <br />At the follo�vin� Iocation / i G �L �.�`L�—_— --- <br />(Work to bt done) <br />- . a .' �.'". / � � ; i <br />�RIVEWAY SECTION <br />VJ SCAL[ <br />. _..._ _. . _ . .� <br />_ ___ <br />cI_`_-,, ,�P .---�I�I <br />I��JC�" . .�_._ . �!'30�1 <br />i UPY OF Tf�ll � APPLIC 4llON l�0 <br />��f_ POSTFD ON JOl3SI?[. <br />� !1'. �_ PNG�PJPEFIfJf3 i)f-h (. 7li�� fi`S", : <br />.'.1 : I.�UHI. UI I ��hi �l7fJ'. i iil.'��. i IUIJ � <br />�CHECK LIST <br />Water Valve � <br />DrarIr inage <br />`-Curb fi G�tter_ � <br />LSidewaik <br />Inspec�or's Siyn;tu�e <br />Jate <br />Hem,�rks ._ _ --_ _ _—...__ _ <br />The undersigned .iwner hereby 39rees ro hold and <br />save hannless the City of Everen. from any and all <br />claims for dam, 3es tha� may a isr. because of installa� <br />tion and maintenance of the improvement he:eto <br />applied for and further agrees to remove same upon <br />notice from the City and to replace public propert•� <br />dany�gedthe� �� _/� • <br />,�.��.� ����I_G' _ Y �-�.� - <br />Sign re n�Af P�'�n�� j! <br />� .Q.z� <br />ne�:s �y�S3`� <br />� j i <br />Telep� nne Ni mbe � v �� <br />Dat� <br />� � <br />'__.__ Lr_._.__..— _ _ <br />Fee <br />�enc. l���o�a�5 <br />� / <br />En9ineers.__ �. L: ; , ..... , __ ...y,...-.,.,. <br />Water_.__ _. ._... _ — — ... <br />Sireet <br />Communications ____. <br />Planning , <br />Notc' Onginal to Customcr <br />, ��>�,� ��, .�,�,. 11 n�. 9 ---- <br />1 Cu�iy to Ins�.r��w�. � AUprored by <br />Dutr. Appiovad <br />