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APPLICATION FOR RIGHT-OF-WAV USE PERMIT <br />�ocren <br />�i <br />CITY EIJGINEERS <br />EVEREiT,WASHINGTON <br />The Unclersigned —1 �/Y� E/a <br />Hereby applies tor permission to <br />C� N. <br />10182 <br />PERMITNO. ��'y � <br />At the following locatic�n_ �, B�/RL pL— _ _ <br />(Work to ce done) <br />ND TE; \ <br />!./�1TER SEiPI�/GE T1J BE L�7CA� <br />BEFDRE ,�URING ClJNCf�ETE <br />OY�l1/�W/aY. A/OT/FY INR7�k <br />D�/�T F�R L �CHT/ON /a T 259 - <br />URIVEWAY SECTION <br />NO qSCALF� <br />r��--__— CS —._ __ _ _ . - � <br />� \ � Y� LIP <br />i.3_O_'i_ _ . ..- �Q I i30'"I <br />�I;OPYOf iH15��ITLICl1ll�ifalC) <br />� BE POST[D ON JOUSI T F. <br />� L'ALL [NGINEER WG DEPT. 259�Ss; i i <br />�d ri��uH�� ���� rnitt ruNs i ni ic i ir�rd� <br />CNECK LIS7 <br />Water Valve <br />Dreinage <br />Curb & Gutrer <br />Sidewalk <br />�� \ <br />In�% Y v- < �: . . � <br />tor's Sipn ure � � <br />� (7_._ _ � i _, <br />Remarks <br />Nore: Original to Customer <br />1 Copy to File � n � R 2 <br />1 Copy m Inspector <br />C : (�' <br />/1'� SL'i9L E <br />EX15ilN6 CUR(3, GUTTf� ' <br />,�Lt/D S/DEWALK <br />�� <br />Q_ <br />� <br />na <br />-NEW L'DN�C�E <br />DRl VEIr/NY <br />The undersigned owner here6y agrees tu hold and <br />save harmless the City of Everett from any and all <br />claims f-,• demages that may e�ise because ot installe� <br />tion an� �aintenance of the improvement hereto <br />applied for and further agrees to remove same upon <br />notice iram ihe CiCi and to replac public property <br />dam thereby. <br />�j� <br />Sig re o pp i n <br />ddress <br />256-�d_\ \ <br />Telephone Number <br />oece �� - <br />(J �// � 7i� <br />Fee <br />Approved by %�, <br />�L <br />Date Approved � 5���� <br />r <br />