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APPUCATION FOR RIGHT•OF-WAY USE PERMIT � "i � d O
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<br /> CITY ENGINFERS � AI�1
<br /> EVERETT.WASHINGTON , ` PERMIT NO. �J Pl '- 9 J
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<br /> The Undersigned 1���/`%N� �,`Ai51 �� ,'{;�1 L �
<br /> Hcrebyappliesiorpermissionto:N�pQ�/��t G�/L-/�� f V✓.6L� $BnvLPi/ �i.� '' i%r-�.De�,.'i} '
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<br /> At the tollowing location 3 a�Y G�O/�. ��- - F—�Fil7�F'�c. OGrT/CC ��LOG
<br /> SKETCH
<br /> (Work to be done)
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<br /> DRIVEWAv SECTION The undersigned owner hereby agrees to hold and
<br /> NO SCaLE save harmless the City of Everett from any and ali
<br /> r— --- - � claims (or damages that may arise because of installa�
<br /> ��� ��P — tion and maintenance ot the improvement hereto
<br /> appiied for and further agrees to remove same upon
<br /> 30';,�„ 30" notice (r m the Ciry and to replace public property
<br /> dama Jiereby. �
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<br /> Signatu r o Applicant
<br /> �L���3'/ 6�/Z-�c S ST�%
<br /> A dress �8 �`
<br /> COFY OF THIS APPLICATI�N TO � 2 _� y�� � v
<br /> BE POSTED ON JOBSITE. I Tele�NumMr
<br />' CALL ENGINEERING DEPT.258$811 I [� - {t� _ ;i�Q
<br />� I 14 HOURS [3EFORE CONSTRUCTION� Date
<br /> CHECK UST Fee ,`.� > �� r.` i:
<br />� Water Valve
<br /> Drainaye Dept. Approvals
<br /> Curb &Gutter Engineers
<br /> Sidewalk Water
<br /> Street
<br /> Communications
<br /> Inspector's Signature Traffic
<br />' Planning _
<br /> ate !U/IrP : �.ir. :��u�r�.�soft �,�a �A�er
<br /> IY.Ifj.' w���I0 Psn�n Y/����i
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<br /> Remarks � �1 �� �.: �� , L �..� �/.?n.("s undrr 4�:;�. :
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<br /> Approved hy
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<br /> '�1 �\, CU87'OMar Datc Approved � �,
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