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<br /> APPLICATION FOR RIGHT•OF-WE\Y iJSE PERMIT I
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<br /> �CITYENGINEERS � ��-;� .� � -� . � i
<br /> EVERETT,W.4SHINGTON ' �%� PERMIT N0, i.�' ' � .i �
<br /> The Undersigned SIC�,'7/V �T�.-�'"' "Sf'�c.{ (�/�G.C:i��._=� �N,.�/
<br /> Horeby applics for purmission to�,�1lJ�T� ��) �/S✓'r D >
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<br /> DaivEWAr SECTION i�'�� , j ��;i �/ Thc undersigned ownen c�reby a9rees to hoid and
<br /> N�i SCA�E , j i ' ' savc harmless the City of Everett from any and all
<br /> � � - � � -�� r "�5 -"� � claims for dama9es that may arise because of installa�
<br /> � � � tion o�d maintenance of (he improvement hereto
<br /> � �-- -� ��P --� _- �—; applied for and further agrecs ro remove same upon
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<br /> . � , ,j�� notice fram Ihe City and ta replace public pruperry
<br /> , , , dama9ed thereby.
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<br /> �� `U I ,I) Signature of Applicant - -
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<br /> COPY OF THIS APPUCATION TO � I�� �� I�ry ��:�� Addre�s ---
<br /> BE POSTED ON JO[3SITE. 1
<br /> CAU_ ENGW[ERING DEPT. 259�8811 ���'7 � Telephone Number
<br /> 24 HOURS BEFOfcE CONSTRUCTION � Daje --
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<br /> CHECK LIST Fee —
<br /> Wacer Vatvc Dept. Ap rovals
<br /> Drainaye
<br /> Curb&Gutter �� Enginer.rs � ✓
<br /> Sidewalk '�` Water
<br /> ti Street_�r,j ' �
<br /> ��� Ccmmuaications
<br /> inspector'sSignaturc- ---- -----�— \�) Trat(ic������� --'��L
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<br /> Remarks --
<br /> Notc: O�iqinal to Customer -
<br /> , .o,�Y �o F��� 10 3$ 2
<br /> 7 Copy to I nsper.tnr APProved by
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