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APPLICATION FOR RIGHT-OF-WAY USE PERMIT
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<br /> CITV ENGINEERS � —
<br /> EVERETT, WASHINGTON � PERMIT NO. �__�__`___
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<br /> The Unde�signed ��/(,J�L L_.:a-lit.�-__ � N C�: P-L �1 N __ _ ..
<br /> Herr.byappliesforpPrmissionto � L.�:�� �1 + �r�_�� � �' (� �. L���✓L ��/r.�� .�' _
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<br /> � (I''' I ��L�I�;' �.+ � L U r 'f _
<br /> SKETCH
<br /> (Work to be done) . '�d �" *� �1, ,� � � � �.
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<br /> Dt+ivEwav SEcrioN I I The und signed owner hereby agrees to�hold and
<br /> No SCaLE � save harmless the City of Everen from ar�y and all
<br /> r � - -- .a � , - � v claims for damayes ihat may arise because of installa-
<br /> �i UP _� 'Y�'r� ' tion and mamtenance of the improvement herero
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<br /> � -_-_� �`r'il'OX��b���'� � aPPI ed lor and further agrees to remove same upon
<br /> �30" —� � �, .�30���f .`� ! no c rom ihe Ci�y and m replace public properry
<br /> � `_ � � � ��' �'� d� ed �here6y. , .
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<br /> ture of �licant
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<br /> Telephone Niimbei ... .
<br /> � � UEP f. 259�Hd 1 1 �.. ..
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<br /> ��ri1J�.� 1-HU('.11�lr, . r���1�) , Date - �.���I
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<br /> CHECK LIST FP�
<br /> Water Valve � - -- Dept. Appl'ovals
<br /> Draina9e _ . . .� �. /i i,�.
<br /> Curb&Gutrer _ , � i Enylneer/� /�t �/rc.,+[�[. ��. .
<br /> Sidewalk . . . . Watei_ `��— -- /P�),�
<br /> �� �1 A,� � Street �� � ��
<br /> `. ��. . /^p.t� ., L. !"U . /�In,�,,,� � . J� CnmmunicaY..ns.' � � . . .- ,„�..fi. �i./ �. .
<br /> Inspv�i�r'S Signature ( � I:� � �...A_,�;!� , . . t Traffic ���� .� � _ _ �
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<br /> Plannin` _ �
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<br /> Hcmarks
<br /> Notc: Oi iginal to Customei
<br /> 1 Copy to File '� n��4
<br /> 1 Co i In Ins mctui A������ � � . . .
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