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'i <br /> APPLICATION FOR RIGHT•OF-WAY USE PERMIT � <br /> ..retl � <br /> e � . � sos77 <br /> CITY ENGINEERS ., -����C/ ,/ � <br /> . EVERETT,WASHINGI'ON � ,,.�. PERMITNO. �r / 2%'r'" , <br /> The Undersigned l�,�� ;� . ,� � /�./. ,. _ - . � I <br /> Hereby applies for pertnission to -,�n s� , - �� : �u�,,..-� . ��- �- h%..� -: -. t�.. ,.��j?/- . y :„ � -. � � <br /> �. f r- /�,.� �„b �� t r,�. �,'�: ,� ' � ! <br /> At the following location ' <br /> , SKETCH <br /> (Wor�C to be done) � ��. <br /> 1 <br /> - I <br /> __T_ ., I <br /> � 9 � �Jo ilo � � � <br /> e.:r , <br /> � y ���: � � �4. <br /> � " �;- � , <br /> . �.,. , <br /> ->/} � <br /> l t\ � I q <br /> \ v 3 ' <br /> �j / 12 3 ' <br /> ` (.���lL I�PJII:fI/1� Il' � � <br /> 'l <br /> T � /k � '� U�iOa.�.,./J 4 � y � .. .. <br /> J <br /> - {`IJn'i•�• ? -1r:— . <br /> � I <br />_ � I � <br /> i <br /> . . Ip <br /> � t � <br /> ., ' f . . . �' ' <br /> � <br /> I ' <br />� <br /> �, DRwEwav SEC7i0N The undersigned owner hereby agrees to hold and <br /> ' NO SCaLE save harmless the Ciry of Everett from any and all <br />' �I �'�— — ---"'I claims for damages that may arise because of installa� . <br />, ; � `�" ��P tion and maintenance of the improvement hereto <br /> , applied for and further agrees to remove same upor <br />. . 30'�,_ _ _�30" notice from the City and to replace wblic properry <br />, i dama,q d�er <br /> I , �C-( <br />� ; � Signature of Applic'jnt n '� � <br /> i =_— /Jn � 6r�J'ii�o�7 -�>-.c_ <br /> � COPY OF.THIS APPLICATION TO Ad r�ess - ''' � <br /> � BE POSTED ON JOBSITE. � � S�' � ��S/ . <br />� ' Telephone Number <br />�I C�LL GNGINEERING DEPT. 259�8811 � _ � _ 77 <br /> � 2�3 FiOURS 6EFORE CONSTRUCTION Date a, � , <br />, / ' I <br />�� GiECK LIST Fee �� <br /> wacer vai�e Dept. Approvals <br />� I Drainage � /1 �,/ <br /> Curb&Guttcr Enqincers_Y. -/'v�f�r�l' 7�hL7 7 <br /> Sidewalk � �{ � � 1� e Y � <br /> � Water �•w_ i e _ .�/. -�Y!l�.r^'�.�..���--� s <br /> i �, "� � " � �',., <br /> - . Street_— i <br /> i <br /> � Communications ! <br /> ' Inspecior's Signaturc . Traffic � ; <br /> - Planning ', <br /> - �:'_.�� n � � � `' �, <br />. ate - � �T��� � <br /> I <br />�' �� _ . 'i Remarks . �, <br />'i - <br />� , �� Note: Original to Customer c . � <br /> � caPy �o Fi�e 1.0 D77 <br /> 1 Copy to Inspec[or Approved by <br /> I� � . , � �� DatcApproved <br /> , <br /> �a.�. <br /> �a«w <:. <br />