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APPLICATION FOH RIGHT-OF-WAY USE PERMIT <br /> � everefl 10 8 8 4 <br /> � i <br /> CITY ENGINEEPS -�_ � � <br /> EVERETI�,WASHINGTON PERMIT NO._�_��__ � <br /> � <br /> The Undersigned 7_��_/1�Al� tiJ� ' — � <br /> Hereby applies for permission to �' •�� �! � L .fZ %� f.J S ' I�� P L ��.' ' a A r' 7 ✓ A� � v.i -� ' <br /> � <br /> %, � �".;AI✓! �( v� � r Fwi57i C �a i � <br /> At the following location ��T�„_ D..�� L��-�,/ — �-- - � I <br /> SKETCH , <br /> (Work to be done) <br /> 5,'r /� 7rfiCi�/t�� � <br /> I <br /> I <br /> � <br /> � DNiVEwAv SECTION The undersigned owner hereby agrees to hotd and I�I' <br /> No SCALE save harmless the Ciry of EvereU trom eny and all �I <br /> � --- --- -- � -+I cleims for damages that mey erise beceuse of installa• � <br /> tion and maintenance of the improvement hereto <br /> �I" ��P --�1 app�ied for and turther eg�ees to remove seme upon �� <br /> �30'+_ --r-- �.30".� notice iram ihe City anA ro replace public properry 'I <br /> � damaged thereb . i <br /> �� Si� Wreo Applica�_, U�j'��� � <br /> �, ✓ •( �'l G��1�if• � <br /> � COPY OF THIS APPLICA7lON TO � Addres�s / / <br /> ! /i[– �` .} �/� I <br /> BE POSTED ON JO[�SITE. Telephone Number� ' ' <br /> CALI_ I�NGWF.I�RINGDEPT. 259�8811 ,�5.� � �.T� � �I <br /> I 7A !iOUR; IlC FURC CONSTRI IOTIC)N Dete i <br /> iG `� <br /> CHECK LIST Fee ' <br /> Woter Velve Dept. ApprA�91s <br /> D�einage (� ��' <br /> Curb&Gutter Engineers , <br /> Sidewalk Water_ , <br /> Strcet <br /> Commwiications_ <br /> Inspector'sSignature Twific __ '� <br /> Planning y� // f �/ /y- i <br /> ' �4..y� J�A'E L'l/1 4/� i�A�I7 �!I- ^ '' <br /> �te <br /> Remarks <br /> Note: 0�iginal to Customer ��� <br /> 1 Copy to File '�.n�� 4 <br /> 1 Cupy to Inspeclor Approved by . <br /> Datc APProved <br />