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a <br /> A,APLICATION FOR RIGHT-OF•WAY USE PERMIT <br /> ev� 1���9� <br />� <br />, C!TY ENGINEERS 7 J � <br /> EVERETT,WASHINGTON PERMITNO._�__ <br /> I � <br /> The Undersigned ir ✓SSF; t ,�1 �?/i/�_L <br /> HerebyappliesforpermissiontoL,�r,ni�?','.�% ` L - ? .; � A <�i?.�fa � [J�,_� Y � <br /> � <br />�I At the following location r iO)N D ui/? i! �Y� 7 z> �+��' ) <br /> SKETCH <br /> ' (Work to be done) ' <br />� • . ..'�i'•� tQ�'✓nG.r'��� <br /> i <br /> I <br /> I ' <br /> I <br /> I <br />� <br /> i • <br /> " � <br />' ' <br /> � <br /> � <br /> I <br /> �. <br /> DRivl'War sEC7i0N The undersigned owner hereby agrees to hold and '� <br /> NO sCaLE save hattnless thc Ciry of Everett from any and all <br /> �'-- � claims for damages that may arise because ot installa- <br /> � �I" LIP � tion and maintenance ot the improvement hereto <br /> applied tor and further agrees to remove same upon <br /> 30'�J„___ _ �30" I notice from the City and to rep�ace public property � <br /> .� <br /> damaqeq thereby. , i <br /> � igna ure o Appl�anC , � <br /> , � -_ _ _ _ ///l'//L� � �k � 7�r_t«vb'F <br /> � �I COPY OF THI��•AP�'LICN i ION TG � Address ��a,.� . <br /> � C�E POSTEO ON �0(351T[. � �S '-�— �/C b'S - : <br /> CAIL ENGINEERING DEPT. 259-9871 II TeiephonepNumber <br />� � 2a I-I�Uf;S E1�F(1R[ COn�57RUCTION� Dale <br /> Y — /~/ �— � �7 <br />� i <br /> CHECK LIST Fee� �Ly �?' ,�� � / l' <br />� Water Valve � Dept. A prOvels <br /> Drainage � � <br /> Cwb&Gutter - Engineers � � � <br /> � Sidewalk Water � <br /> Street <br /> . . __ Communications ____ � <br /> Inspector's SignaWre , <br /> Traffic <br /> Planning ' <br /> �late — i <br /> Remarks <br /> Note: Originel to Customer �� -, <br /> 1 Copy to File nCi 9 <br /> 1 CoPy to Inspectoi � ! '•. � Approved by <br /> Datc Approved <br />