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everen <br />e <br />CITV ENGINEEHS <br />EVERETT, WASHINGTON <br />APPLICATION FOR RIGHT-dF-WAY U:iE PERfvIIT <br />The Undersigned �:_ .—.�. �- " <br />Hereby apUlies tor permission to � <br />� <br />� <br />r l <br />i<., �-_, <br />At the follawing location -� ;- �1`-�Z�^�� -^ •=i_ t" - <br />SKETCH <br />(Work to be donel I <br />� <br />DRIVEWAY SECTICN <br />NO SCALE <br />�- --- G� � <br />�r� uv �-7� <br />���,�--�— _--- �;�.' I <br />�t <br />COPY OF THIS APPLICATION T6 <br />ftE POSTEU ON JOBSITE. <br />t'l�L� EN ,�tJf-CRING f�CPT 769 til, � I <br />'�.I�;��il;��f'liilitl �:r)';':�iHU� lin:: <br />CHECK LIST <br />W-ter Valve <br />Drainaye <br />Curh & Gutter <br />Sidawalk <br />Inspector's Signa�ure <br />__ __ <br />ete <br />Remarks <br />Notu: Onginai to Customcr <br />i conv u� r�i�� <br />1 Copy !u Inspectcr <br />1.OS15 ��� n <br />,�^� <br />PERMITNO.'� �� <br />'�^" 'li;—, <br />. . � �%:_ . E � �'� :.-��t - -� -�, <br />` <br />6u.� ; <br />� <br />-�_ �-- �:�� <br />'j p w P� , <br />The undersic�ned ownen c�reby a9rees to hold and <br />save harmless the Crty af Everr.0 from any anA all <br />r.l.,ims for damages that may arise because of installa� <br />tion and maintenance of the improvement herero <br />apPlied for and further agrecs m remove same upon <br />notice froi the ity antl to replace ub�ic praperp� <br />ciain� ther <br />` : : <br />.� � na e of Applicant � <br />1�i',C�,� =,���� %CI �' <br />Address <br />�_.G3_ -�.�`,-Q / <br />Telephone Numbe� <br />Date ---_- _--�f1� / -�� <br />Fee r <br />1. 0 51 5 --- „ y9—y - , <br />F1Pproved, t� , - `� -- / /� <br />---- 'iL <br />Datc Aupioved <br />f� <br />