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— �f'PL4CATION FOR RIGHT-OF-WAY USE PERMIT <br />cvcrctl <br />� <br />CITY ENGiNLERS <br />EVERETT,WASHINGTON <br />The Undersigned _ L _� i <br />Hereby applies for permission to _! ��� <br />At the following location_[, '.�r�_ `� �. � -__?�_...�_� " _ <br />_.,_�:.; -_.� <br />SKETCH <br />(Work [o hr. done) <br />DRIVEWAY SI'CTON <br />NO SCALE <br />�—__ _. _ _ - __ _ _ . . .. J <br />I <br />r� �I" LIP ._ � <br />I..��'1" �_- . I 30 I <br />-��. .� <br />coi��ror iriisnF�i�i.icn7iut: i�i <br />IiE POSTED ON JOBSITC-. <br />r.ni � �_rvcirn rrarv� nri�r �y�,++� �� <br />'�1 II(:UR; HI f UIIF CON:;II;Ut'll�,... <br />CHECK LIST � <br />i�.�'+ r�,!'� � '�� 1 /�'' �g�, <br />L' <br />Inspector's Signature � <br />-65ie - _ _ <br />riemark s <br />Note', Original �o Customer j �7 <br />t conv ta File 1 f7 �� �. 1 <br />1 Copy to Inspectoi � <br />iiJ9�7 <br />PEFMITNO,, - '� _ <br />� --....�.✓'': <br />r J/ . <br />The undersi9ned owner hereby agraes to hold and <br />save harmless the City uf Everett ira n any and all <br />claims for damages that may arise because e� installa� <br />tion and maintenance of the improvement hereto <br />applied for and further agrees to remove same upon <br />notice from the Ciry and m replace public prope�ry <br />damaged thereby. <br />Signature ppUca7t <br />�.'"/�'��1-�(_�. ,� -...�� —_'_— . <br />Address <br />� 3=���_- N�_ti y 5yY 1-?n. . <br />Telephone Numbe� <br />"7 7 : � �z'. <br />— ---- ---- <br />Datr. <br />/ . - '� <br />_._�__ . .." . . ._..._ ___ _�____ _ _-_ <br />Fr.e <br />Dept. Approvals <br />Ene�ineeis... '�'__�.____ ._____- <br />Water— -- _- _. ___ .—.. _ _. -- --- <br />Street--_,_---- ---- <br />C;.inmunications _ <br />T�affic-- .- --_ <br />Approved by <br />Datc llPproved <br />