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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> � everett 1 0 6 6 9 <br /> e <br /> CITY ENGINEERS <br /> EVERETT,WASHINGTON PERMITNO.__ _. <br /> The UndersigneA__ --�-- <br /> Hereby applies tor permission to i � , <br /> At the following location ' �' �• -- - <br /> SKETCH <br /> (Work to be Aone) <br /> I <br /> - - �� _.,,�. .— <br /> ; I I ----- <br /> ------ .. _ _ j <br /> I <br /> I <br /> --�.._—..__ <br /> I �r /, ; . , _.._ , -., :. �- � <br /> � . , . . i' s� ��'a � <br /> IICI.(/ �r� YY�� oI�/�. <br /> : � ura/r. do�s „uf ; <br /> �et<JJY P�i��� l� L�.� � <br /> /y�..� <br /> I <br /> , <br /> DRrvEWAY SECTION The undersigned owner herehy agrees to holA and <br /> NO SCALE save harmlexs the Ciry of Ever^tt from any and all <br /> � _ _ _ ._ __ __ . . -+.I claims for d3mages�hat may arise because of installa� <br /> tion and maintennnce of the improvement hereto <br /> ��LiP —_—�� applied for and turiher agrees to remove same upon <br /> I 30,• � i I 30'J notice from ihe Gry anA to replace public properry <br /> �� `� �1� dama9ed thereby. , <br /> /, , <br /> Si9nature--��Applicen��� <br /> Ad ress <br /> i uPY01' lHISi1PPU(�./�Iliifa i��i <br /> ��! POSTFDON .10I3SITL. -' 1 <br /> Telephont Number <br /> i�l L f.-NGINFERING DEPT. 259�9N11 _ _ _ <br /> �� I Il��i iiI': I'I I �1Hl. ��.���,1'�l P���' I II`I; Date <br /> — — Fee -- —�-----�— <br /> CHF.CK LIST <br /> Water Valve Dept. Appfoval5 <br /> Drainage <br /> Cur6&Gutter Engiree�s____..-_-----_---- <br /> Sidewalk Water___ <br /> -- <br /> � ^ Street____. <br /> � C�_ fjl, _/,( . Communications <br /> an.a.p��p L <br /> InspectorsSignature Traffic___._-- — <br /> Planning___ -- <br /> - - - ._._._- . ._..-- --- <br /> 6ate — -� -- — � <br /> - -- - - -.. _-------- <br /> Remarks _— -- <br /> Note: Oiiginal to Customer 10��q __ __ <br /> 7 Copy ro Pile A{>prwed by � <br /> 1 Copy to InsPectm ____.—_ _ __- <br /> Dale APpwved -.. - -- �_ , <br />