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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> evcren i" I I !,� i.l <br /> � � -- -- . . <br /> CITY ENGINEERS � <br /> EVERETT,WASHINGTON PERMIT N0.___ __ <br /> The Undersi�ned - � J ���J� , <br /> Herebyappliesiorpermissionto � �"'i"=�� i ; r} ��r'--f•�=+r•�*r-�-�---�= f�/�,.. .�.��7 <br /> � � . f. � l/./��...'r [ ��r -� � �� 4-�i ? <br /> Atthefollowinglocation �' - � �'� �" i.���� - r'�.�tihc :�/- l=�: � <:= - '� . �� ���-_._ <br /> SKETCH <br /> (Wmk to bc donc) <br /> DRIVEWAv SECTION The undersi,n�,,, .��vner hereby agrees m hold and <br /> NO SCALE save harmles. the City of Everett (rom any and all <br /> --- ---- daims tor riamages thar may arise because of insialla� <br /> r --- - -�, <br /> ��—��iP '�7� tion and maintenance of the improvement heretn <br /> --._ �—J applied ror and further agrces to remove same upon <br /> ^3a'� —� <br /> , �'� � noticoirom the Ciry�nd to•epla�e public properry <br /> daTn��ed ihereby.y',\ } � -- .. ., <br /> �_�t�:��- � �.,;,w��.. . <br /> S�gnature of Applicant <br /> - - - - _ _ -- <br /> ��.p R�X GCR <br /> Address <br /> ', ;;OPY OF THIS APPLICA-iION TO ���.�,��- W A�µ ��7� _� <br /> �� f3C- ?OSTED ON JOBSITC. Telephone Number <br /> � CALL ENGINEERING DEPT. 259�8617 7. ��- � �9 � �3) I i <br /> i 24 HGURS BEFORE CONSTRUCTION Date <br /> CHECKLIST Fee , _ . ,_- , :��� �t<._o . - <br /> �- _ . <br /> Wacer valve Dept. Approvals ' ' <br /> Drainage <br /> C�rb&Gutter Engineers <br /> Sidewatk �9ater <br /> Street <br /> Communications <br /> Inspec+or' i ature - Traffic <br /> � n�� '� � �� Planning <br /> �� <br /> ate <br /> Remarls <br /> i11 � o � , � , �, , — <br /> Approvedb�,.,�i� � ` � :�t,.l , . <br /> '��L��.N•Zl � <br /> INSPECTOR'S COPY Date Approved .. ' �- � 9 <br />