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_ APPLICATION FOR RIGHT•OF-WAY USE„pERM1T <br />everce <br />e <br />CITYENGINEERS - �� <br />EVERETT, WASHINGTON PEHMIT NO. �� - ' ' <br />The Undersigned _ �' � �� <br />Herebyeppliesiorpermissionto =:-��-i�, � - r�i� �'��,'�r�'� �r• -,�7 I j'l���•�,�. r..�.. <br />At the tollowing lacetion � �' i .l � ,. ' . . .� .. � .. .� � �� . . .. � .1-`� � � � t � _ � ) '- <br />�J' , _ .. . ' . <br />(Work ro be donel <br />/ <br />�N�virw g� <br />URIVEWAY SECTiON <br />NO SCALE <br />� ___ __. . _ . . .. �! <br />I <br />� / ��� LIP _7� <br />�30T__..._ ______. -__.�T'30"1 <br />�CpPYOf i1115N'1'I IC�IIOhJ IU <br />�� 131_ PO:;I i-D ON JOf3SI7L �, <br />Cl1LL [NGINEERING DEPT. 259�RH1I ��� <br />� 74 I-'OURS lif I�ORC Cr1N;1 fiU(:l it1P1 � <br />CHECK LIST <br />Water Valve <br />Drainage <br />Cwb & Gutter <br />Sidewalk <br />Inspector's Siynatuic <br />- - --. _ —_ - - <br />bate <br />Remarks <br />Note: Original to Customer <br />1 Copy lo File , <br />1 Capy to Inspector <br />i'! I 7 <br />� �I�. ��" .. i�.��l <br />__ r���-`�_LI• �.]�� <br />0 <br />�--- -- ���� . <br />i �, <br />--- � �� /s' � - <br />t ' C 11, <br />r <br />, <br />- , '� .�:.------� <br />_ , - ----� <br />Nn .�z✓��r- <br />The undersigned owner hereby agrees to liold and <br />save haimless the City of Everett from any and ell <br />cleims for damages thet may a�ise because of instella� <br />tion and maintenance ot the improvement hereto <br />epplied lor and turther agraes to remove same upon <br />nntice }rom the Ciry and ro replace public properry <br />Aamaged thereby. <br />Signature ot Applicant <br />Telephone Number � r3 � �3 g� <br />J J <br />Date <br />A/, r , <br />Dept. Approvals <br />Engineers <br />' � �� � Weter <br />� � Sireet,�;� ��"��`/(/�� <br />CommunicaY ns `J'�� -v'-" ^�'r - � - T � <br />Traific����.-..-�_ 7- � %S <br />,� ' I �--- —_ — <br />Planning; . ,_�,4___� <br />Approved by <br />Date Approved <br />l L• <br />