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APPLICATION FOR RIGHT-OF-WAY USE ?ERMIT - <br /> `"�'�" - 10 3 6 6 y�v <br /> e � � � �, z ����� <br /> CITY ENGINEERS �� � <br /> EVERETT,WASHINGTON PERMITNO. � <br /> The Undersigned �VC"�l� �-'✓•����'I'�. ,�4' - - <br /> Herebyappiiesforpermissionto ,�7.������� t- �� ���JST/�� ( � /�G��'�/� �C <br /> � . _ -/ /:� � /'`iC��iCJ.� 'i/l � �ST/11i1�7S <br /> . > I/ <br /> At the following Icea[ion C � G G ����Y /Q�VE <br /> SKETCH <br /> (Work to be done) C3�O J)� Y �P ����T <br /> / <br /> ,c,,� ,��,e� y //Y5TAL L <br /> �.j�, STE.� ZU�X 7, �" �! ' <br /> `V <br /> I ' � <br /> � 7. � <br /> ,�T N��psT�D�Nys <br /> N.T.S. ��, Zr3z� C �,.� <br /> �z, '�X�sr��vG oc.-�.r.� � <br /> � <br /> � � � <br /> � <br /> E <br /> �v � G��A n�s .1 � <br /> � � �, . � <br /> `; ;�;� <br /> , i <br />� , � I I <br /> i <br />� <br /> � ,y�yYi%T ,� i�'c <br /> I . � DRIVEWAY SECTION The undersigned owner hereby agrees to hold and � <br /> I' � NO SCaLE save harmless the City oi Everett from any and all ' <br />.. , L— ---- --� claims for damages thac may arise because of installa� <br /> � � [ion and maintenance of the improvement hereto <br /> I" LIP applied tor and further agrees to remove same upon <br /> i �„30'+__ _..—�.30�� notice from the City and to replace public property <br />�� �damaged hereby. � / <br /> �L7 L U��?���N <br /> I� Signature oi Applicant <br />� -- - _ _ __. _ ,4 i�� . ��i�;/ S� -�a2 �6P�F.2 _�s <br />� I COPY OF THIS APPLICATIOfJ TO g��'" �- Address 7 �¢-Sh` �OyO ' <br /> I, BE POSTED ON JOBSITE. � �� � 77� <br /> Telephone Number <br /> � Ci�LL t-NGINEERING DEPT. 258�8811 , /-�:��'- ��� . <br /> i "'�i IIOUR'I LCFOHE CONSTRUCTION�� Da[e <br /> CHECri LIST Fee � <br /> IWater Valve Dept Ap r0 als <br /> Drainage � / �_ <br /> Curb&Gutter �nc <br /> '��- Sidewalk � � ater O � <` �� <br /> i <br /> � <br />� i l �- t ' <br /> - SCraet <br /> i ,� - ; > <br /> - - '- � � '-'- � Communi a(6 ns ' v! � � r' <br /> ' Inspector'sSign�ture � Traffic � � ��G , <br /> � - . " Planning /� � <br /> .. � �te q �b SC'l.�ch ! , �"�v iit D SJ�i �',�i,/� <br /> I +! <br /> Remarks <br /> '� Note: Original to Customer 1�3 6 6 <br /> , 7 Ccpy to File <br />, � 1 Copy to Inspecmr Approved �/3Q ,� , <br />. ' � Date A pr ed <br /> \ <br />