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1 <br /> • / i• � <br /> 1 , I <br /> APPLICATION FOR RIGHT-OF•WAY USE PERMIT <br /> everett <br /> � 10992 � <br /> CITYENGIN[ERS ���; � � <br /> EVERETT,WASHIN(;TON PERMIT N0. <br /> The Undersigned �t�_">S:�"� L �1f �"r1�Ll. I <br /> Herehynppiiesforpermissionto(�nsrJ�':-^;":+C-y 7_. - �n � /k<,_f>i�iF,(.T" n/��'S � <br /> "-z-2-=7� - .l <br /> —�- <br /> At the foilowing IocaLon_� _-,'.•s�a �:.��5'/#?;r ,,.; a' '"••, ^r+ . r � , <br /> / <br /> SKETCH <br /> (Work to be done) � <br /> .'�r/5� ���.�N.i,'!.� ' <br /> �'�~ � � <br /> �� a <br /> �oo� � <br /> e��I F°� � <br /> � Q Q�� ��e S <br /> o � � � � �, <br /> b�'x QJ1 1 � <br /> ek <br /> DRrvEwAY SECTION Thc underci��ed owner hereby agrces to hold and I� <br /> NO SCALE save harmless the City of Evcrett irom any and all <br /> f'---- ----� claims tor damac�r.s tl�at may arise becausa ot installa� <br /> �" LiP tion and maintenance oi the improvement hereto <br /> zpplied tor and furiher agrces to icmove samc upon <br /> �3u_'�__ ______ ._ _ . _ _ _,+,3Q'� notice from the City and to replace public properry <br /> dam e thereby. � /, <br /> igna�ure ol A lfi ant�E``�5/�� <br /> ///C�/ /1/,= �%''� T;.:tc��;C� � <br /> COPY Of THIS APPLICATION TO Address c�{�`r�,7 <br /> BE POSTE�ON JOBSITE. `�ri"-�/C>S�� <br /> CALL ENGINEERING DEPT. 2598811 Tetephone Numbcr <br /> 24 HOURS BEFORE CONSTRUCTION Date � -f �-7� <br /> CHECK LIST Fee'7—, - ' <br /> Water Vaive Dept;Appl'OVq15 <br /> Drainage ' ..y i� / � <br /> Curb&Gutter . ' Engineers �'____;r_c �-/'z...` <br /> Sidewalk <br /> Water <br /> Strcet <br /> Communications <br /> Inspcctor's Signatwe Traftic <br /> Planning , <br /> ate <br /> Remarks <br /> Note: Orig�nal to Customer ' � <br /> 1CopytoFile 10992 <br /> 1 Copy to Inspector Approved by <br /> �J <br /> i <br />