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APFLICATION FOR RIGHT�OF WAV US[ PERMIT <br /> �°�'�" 1 � !3 5 <br /> � <br /> I CITY ENGINEERS �� ^ <br /> EV@RETT WASHINGTON PERMIT NO.�_�. �. <br /> TheUnder<igned _�.__�-��--._-- _-__---_'-___-._-. <br /> Hereby apPlie�,for permission to -:�,+' .i r r- i J ��. `>� i�5/i.�J,. r �.�__ _ ��% i%.....��..�— <br /> At the tollowing Iceation�-�--'� -f s i�. J _ --_--__ .. . .---- I� <br /> SKETCH <br /> (Work m be tlonel <br /> �.. i= i' �: ;'i ia C /f'� � ,. <br /> �4i�/FWAY SEC7ION The undersigned owner hereby agrees to holA and <br /> A'> '�CAi E save harmle.ss the City of Everett from any and all <br /> l..- - ----�- -- � 1' claims fo�damages�hat may arise because ol installa� <br /> I <br /> - � tion and maintenance of the improvument hereto <br /> �� �I" LIP �pplied fm and furlher agrees [o�emove same upon <br /> �30'��- �,.3���.; notice trom the City and to replace public properry <br /> '� � dumaped thereby. . <br /> i ' . . --�---'- -�"�-/ <br /> �i'gnat4r'c�o(Ap�dicant <br /> �~ � � � <br /> � ruPY OP THIS /�PPI IC��I IiIN i� � Address <br /> I;h Pp$TLU ON JUR511 L. - � - - - - <br /> Te'lephone Numbet <br /> � ALLENGMCFRINGDEPT. 259�BHi ! . 1 .� � � <br /> . __. ._..._.-- -_. . <br /> . : �niUN; l311 (1171 �:ClFJ1,iRU�� li�)f�i Date .�. . <br /> ! . <br /> ____ . . __�5.�..___..___.____. ___- <br /> CHECK LIST Fee <br /> Wa�er Vnive Dept. Ap;'�rovals <br /> Diainage '� <br /> Curb&Guller Engineers_ �_�y.i:Ltm,..'. ... <br /> � Si�fewalk_ Water.�,y�,] I '/. . . �'�'��s.�s��� <br /> / /�� � r <br /> _ . .. , = Street_.l,.�1"_„4-_��c-L.u17� . <br /> Communications _ <br /> Inspector'sSign;�ure � Traffic <br /> Planning___� _- - <br /> Daie ...__. . .__- _ y �; � ✓�) / .���„a�ja„�x �_.._....�/.� i. . �,,,. <br /> - ---- - -. -. _ . _. _ .___---- . . <br /> Remarks <br /> Nolc: Onyuial �o Customcr � <br /> I Copy to File '�.�7�5 -� <br /> 1 Copy In InsP��:to� ApPruved by <br /> Date APP�uvcd . . . . . . <br />