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5716 EVERGREEN WAY 2016-01-01 MF Import
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5716 EVERGREEN WAY 2016-01-01 MF Import
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Last modified
2/9/2017 9:20:40 PM
Creation date
2/9/2017 9:20:29 PM
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Template:
Address Document
Street Name
EVERGREEN WAY
Street Number
5716
Imported From Microfiche
Yes
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APPLICATION FOR RIGHT-OF-WAY USE PERMIT �r <br /> everetl <br /> _ — � :"l / i" <br /> � _L '-J ,_ . <br /> CITY ENGIMEERS �7 <br /> EVERETT,WASHINGTON FERM:I"N0. / �' �'�� <br /> � <br /> TheUndersigned �D�.��)N / n� ; <br /> � � I>/u� <br /> HereLy applies for pertnission to .,��.N��/'�cT F} 3d /�S�f1Pt-' _ <br /> Atth; followinglocation S7/6 �Vv:?����Gr/ �Gi�7i /�r�Art/S �/%Q ✓6�s� <br /> SKETCH <br /> (Work to be done� <br /> S G'F ✓-3-rT/-1 c r��r� <br /> DRIVEVrLY SECTicu The under,igned owner hereby agrees to hold and <br /> NO SCaLE save harmless[he City of Everett from any and all <br /> r-- � claims for damages that may arise because of installa- <br /> +I�� LIP � tion and mai tenance of the improvemer.t hereto <br /> applied fof nd further agrees to jemove same upon <br /> 30" _ _L30" I notice f the City and re lace pu �c property <br /> �� r�� ::��� <br /> dar)r gad thereb <br /> i <br /> 'gn ure of Applica� <br /> � S'—�-- Z�v <br /> COPY OF THIS APP,.�CATION TO � Address <br /> BE POSTED GN JOBSiTF. �D����� <br /> CALL ENGINEERING DEPT. 259�8817 Teie hore Number <br /> c� Mro2cK I�f`17 <br /> 24 HOURS BEFORE CONST�UCTION Da[e � n <br /> — — /S -— ��t'�. <br /> CHECK LIST Fee <br /> Water Valve Dept..ApproValS <br /> Dreinage c n�/ > ' <br /> Curb&Gutter Engineers_ S- L�j�i�C�� / _ <br /> Sidewalk Water , �l�?'.�!..z�p,�,!i71'�r.zti, / 4.ih..� <br /> Street <br /> Communications <br /> Inspector's Signature <br /> Traffic <br /> Planniny <br /> ate Se.�-;✓� _-.� , .� f1(���_,,. . �i� f�w . <br /> r" � <br /> Remarks <br /> Note: Original to Customer <br /> 1 Copy to File � �7� "+ <br /> 1 Copy to Inspector App�oq �by � . <br /> 5. �('u. — , <br /> Date Approved ' <br />
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