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n <br />everetl _ APPLICATION FOR RIGHT•OF•WAY USE PERMIT <br />� � 10876 <br />� CITY ENGINEERS <br />EVERETT, WASHINGTON PERMIT NO. �' � <br />� The Undersigned l�^�: r� .� 1/> � r'i ��.T <br />� Hereby applies for permission to �r: i�l,= w (� v"i i3 � i� F�/ -1 rT c h-'i l'- f}s f} <br />, - �/"A�.ili=i�'.,CTi�a/ i�'JTFc'7'� Oi•i '�� T�ni <br />. At the following location '7 �/ 3/ G" ��'r^ �;�� ��� r <br />(Work [o be done) <br />�RIVEWAY SECTION <br />NO SCALE <br />I � <br />jl" LIP � <br />30'�-_--_.�.,30 I <br />y� <br />COPY 01' THIS r\PPLICATION TO � <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 259�BA11 <br />24_I-IOURS E[FORL CONSTRUCTI� <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />nspector's Signa[ure <br />Remarks <br />Note: Original to Customer <br />7CipYtoFile '���76` <br />1 ( opy to Inspector <br />S�G F}TiR�ii�.;n <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of E��ere[[ frorn any and all <br />claims for damages tha[ may arise because of installa� <br />tion and maintenance of the iraproveme��t herero <br />applied or and further a e o remp0e"'�ame upon <br />noU f m the City a J�r �re lacj,, /p�u Hc �operty <br />da ��.i ie�-s�iC _ / �1/i� -:.;[?'� � � <br />'.s = �306 <br />N a Pi� � <br />Fee <br />Dept. ,� provals <br />�/ �7� •� ' <br />Engineers S�i'�Li�i�ET - <br />� <br />Communications <br />Approved by <br />Date Approved <br />