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APPLICATION FOR RIGHT-OF-WAY USC PERMir
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<br /> � 10371 ;�� .
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<br /> CITYENGINEERS � ,L��
<br /> EVERETT, WASHINGTON PERMITNO. �
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<br /> � The Undersigned yJ '�L-✓'-�L�i T`J�/"�/ �/�—�-�'�/�' I
<br /> ' Hereby applies for permission to Gr�'lV��v'>/�� � �—!i�/ST L� ' Z � <�'-�;:� . ,J/��-� . �
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<br /> At the fnllowing lucation �'� ���� �i%'—`�''��/.c� -� //J/�.'�'r� i
<br /> SKETCH EK/ST. /NLC'j
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<br /> E�isr /c.^'SJ�V. SEi�YE� ,�S;YI:a�r — f�--
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<br /> � DRIVEwAv SEC710N �� . The undersigned owner hereby agrees to hold and �I
<br /> 2 NO SCa�E save harmless the City of Everett from any and all �
<br /> � f'—'— Z� � . claims for damages that may arise because of installa- �
<br /> �. i" t.�P ' ' tion and maintenance of the improvement here�:o '�,
<br /> 30" I_30" �pplied for and further agrees to remove same upon '�,
<br /> . �---�+--�---�--+{ �� notice from the City ar to rep ace blic property �
<br /> dam�ed ther by. � !�`�
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<br /> , \�,Y \^� S:�na �of Appli ant � � �
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<br /> COPY OF THIS APPLICATION TO ���� (V A��S . . ,.,�,,L ���� �'�
<br /> BE POSTED ON JOBSITE. /�'i� Geu.��•
<br /> � Tclephon Number
<br /> � CALL ENGINEERING DEPT. 259�8II11 � _, s��� �
<br /> I_2�7 IIOURS [3EFORE CONSTRUCTION Date ,:. ..
<br /> _- _---- - -- 3� � �G
<br /> _ �l.r:.:, .
<br /> CHECK LIST Fee ' ��_ '�
<br /> Water Valve Gr' 2/�1(.�� ��
<br /> D� pp o Is 2 I
<br /> Drainage d
<br /> Cur6 &Gutter Engin �/ :
<br /> Sidewalk � " -�� ' Water �a-�, e � eatSehc QG,.rJ '
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<br /> � Street '�i-`/ � �
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<br /> .�-'1.� Communic ti ns �
<br /> � Inspector'sSignef e � � � �� I
<br /> � Traffic
<br /> 5-- � L•,._, J (�j, cPianning � / G- !
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<br /> ate V_�[rP� �laa<��/JSOH �l3�� ;
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<br /> � Remarks �i
<br /> INote: Original to Customer i
<br /> I 1 Copy to File 10371 � I
<br /> 1 Copy to Inspector APP�a � Y .
<br /> � Date pproved I
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