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. APPLICATION FOR RIGHT-OF�WAY USE PERMIT <br /> ""�" 10923 <br /> � <br /> CITV FNGINEERS <br /> EVERETT,WASHINGTON PERMIT N0. � � � <br /> The Undersigned J ' ._ - ___ ._.. <br /> Hereby app�ies tor permission ro__,_y_�•_.��'.. -� . j � �;,'�� � r � <br /> � <br /> At the followinp loca[ion - ,, � ,� . i 1,-,-�__, � . <br /> SKETCH <br /> �Work [o be done) . � <br /> 1 <br /> � DRIVEWAY SECTION lhe undersigned owner hereby agrees to hold and <br /> NO SCaIE save harmless the City of Everett from any and all <br /> r---- ----- -- - -�{ claims for damages Uiat may arise because of installa� <br /> � 'i" L�P __� tion and maintenance of the improvemenl hereto <br /> ap�ilied tor and further agrees to remove same epon <br /> �30'� —�� �3�"� notice from the Ciry anA to replace public property <br /> d age thereby. \'' __y�-- <br /> �—Llsi�/, .,`____.._— <br /> naWre of Applicant <br /> —�� �_:L1�-�t1�1_f�c�l./.o l� R rR",). ,,,,/ <br /> i <br /> �'UP� UI il;l_� APPI ICnllirtJ Ii � qddress ,� yC,�.n <br /> HLPOSIEDUN .,013511E. � '/ '� - I '. Z 2. <br /> IC�LL [NGIN[FRWGnFPT 2'i9 '+'�� �� TelephoneNumber <br /> �£S `� 'Z7---- -- <br /> . : �+IliiH; ll: l ��;! � . ..,"ti•r:11�C.; Da[e . �� <br /> .—.—_. ' .L- /�_ . .� � — <br /> CHECK LIST Fee - .' <br /> Water Valve Dept. ApproValS <br /> Dra�nage <br /> Curb&Gutter EngineersJ__7.. <br /> Sidewalk Water_ <br /> --- -- <br /> ,n - Sireet _ <br /> �(X._��._ LtCC�+- _ . _ . Communiwtions _ <br /> Inspecror's Signature - <br /> Traffic <br /> Planning — <br /> ��17 � - <br /> �at�� ---- <br /> Remarks <br /> Notc: Onpinal to Customer <br /> 1CopytoFile ��q?�� � ----- -- <br /> 1 CnPy to hispecmr APProved by <br /> ,--.. --. .._..--- - - - . . _ <br /> _ Dab: l�p�noveJ <br />