5716 EVERGREEN WAY 2016-01-01 MF Import

APPUCATION FOR RIGHT-OFWAY USE PERMIT � ' _ everen q O��7� I � � 1 J �1 i �' CITY ENGINEERS -^ ^ , � , '� � EVERETT, WASHINGTON PERMITNO.__. � ' � �_ IThe Undersigned � � � � Here6y appli^s for permission to � � ' I� I _ /. 1 , _ i IAt the following location �� -� � � � � ' : � � ' iSKETCH � ' (Work to be done) • i I _ . . 1 � , I I � ; I , I � i � � I I � I I, I I . I I � �i I � � I II I . � I I I I . � � �RIVEWaY SECTION � The undersigned owner hereby agrees to hold and I ' NO Sca�E � save harmiess the City of Everett from any and all ' ! �.--- — —� claims for damages that may arise because of installa� ; � t „ �P tion and maintenance of the improvement hereto I II applied for and further agrees to remove same upon � �, �30';,h__ _L30" notice from the City and to replace pubtic property I i � damaged thereby. � . f/ I ��,-: , . ( ' �. r� -- l/�- I i � Signature of Applicant � � 1( ;, l;'� " � T � I COPY OF THIS APPLICATION TO Address � , ` / �I ' BC POSTED ON JOBSII'E. -��`- �� ' ' - - -- I i Telephane Number � ' CALLENGINEERINGDEPT. 2598II71 <:= . ! , �� i'� �, � 24 HOURS BEf-ORE CONSTRUCTION Da[e ' i -,t; � � --- !_, . CHECK LIST � Fee I i Water Va�ve Dept. Approvals I ' . Drainage � ")1/ , .,� 'I Curb&Gutter Engineers _ , i � Sidewalk i Water :�.�--, ��'� -1�' +. _ � ; i . . . . , -- � i Street ` I �i Communications � Inspector's Signat e � Traffic ! --- � i � �jl� Z 7 Planning .; i � � � _ �� . ' .� R I . I I �� Remarks I , Note: Original m Custamer n � � '� . 1CopytoFile 11J7�1 . �� �� 1 Copy to Inspector Approved,by ',, �' Date Approved �