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evcrett <br />� <br />CITY EN�iINEERS <br />EVERETT,WASHINGTON <br />APPLICATIQN FOR RIGHT•OF-WAY USE PERMIT <br />1051�. �wF <br />�1 <br />PERMITNO, 7E -' l39 f � <br />� <br />The Undersigned P P i' P i`I e w� �; n c� <br />Here6y applies forpermission ro Con r}r �,. r � 'i- 7 5' A c��h. �/vv ��-. C; f�, l�-D-V[/. _ <br />i <br />At thc followinp location _Znl 4 C-' .�r-o �een W n. <br />J � <br />SKETCH <br />IWork to be done) <br />- ��- �r� <br />,T ; <br />N O <br />� �- i <br />i.�'�q �` <br />�� <br />P� <br />� Q <br />\ Q <br />�1�� <br />0.. <br />I� <br />DRIVEWAY SECTION <br />NO SCALE <br />�-- - Z-z� =---i <br />r� j I" LIP <br />h.•30 —_—_—�j"30'y <br />�COPY OF THIS APPLICFlTION TO � <br />8E POSTC-D ON JOBSI TE. <br />CALL [NGINEERING DEPT. 259-BE31 I <br />� 24 HOURS E3EFORE COPJSTRUC�TIOld� <br />�.HECK LIST <br />VJater Valve <br />Drainaga <br />Curb & Gutter <br />Sidewalk <br />Inspecmr's Signature <br />Remarks <br />Note: Original to Customer <br />, ��PY �� F��� 10 511 <br />1 Copy to Inspector <br />,2 �M/N �fYVt]S44�NG <br />R,�Qu��._=.v o�J�vr'��uvAr= <br />l�/�G�F�E/� i7 —.. — in' <br />;t>i�s <br />�3�,,,�, <br />f I; 4c <br />�I�i <br />� -I--- - - - --' - ----- � "nri <br />tr.��.>::�:I ' , �. <br />l�l H � � e� <br />t '7 <br />�� 1 <br />� <br />Plofe lyp ;;cwcr or .�vnte� "te.••s". <br />jz c �i r 4 ��I�7 <br />No Scq/o <br />�/'f t/.,/�c <br />0 <br />The underslqned owner hereby agrees ro hold and <br />save harmless the City of Everett from any and all <br />Q�1 `? �{ c�aims for d-imayes that may a�ise because of installa- <br />� tion and maintenance of the improvement hereto <br />applied for and further a9rees to remove same upon <br />notice froin the City and to replace public property <br />dama� �ijereby� <br />i %� 1/� _C_i�� <br />Si amre�irnd t <br />.:>>C � ;-/-// f � <br />Address <br />) � i �"'// l/ <br />Telephone Number <br />Sewe/-, <br />vom <br />' 0 �p�2f�r�i� <br />�� rzs.�� � <br />Fe'c 7��' <br />APPr��/i7 /�7 � <br />Date Approved <br />