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�y"�.v, qpPLICATION FOR RIGHT-OF-WAY USE YtRNII l <br />everetl <br />� <br />CITY FNGINE[RS <br />EVERETT, W.4SHINGTON <br />The Undersigned <br />HefCb�' OPFII?c {nr nprmiccinn tn <br />D <br />10�1� �j�� <br />�/ -!�� , <br />PERMITNO. 7� -.'S-�� <br />— ' <br />At the following location '�C �al 2- 2 2 Q.�n ,�� fn X f� vF <br />I <br />SKETCH <br />(Work to be done) <br />1 V <br />- —� ¢ ro��{r,X A�c <br />qn• R/w <br />E,/ � t.F c CpR. pnvrn�, ��' <br />�-consi'/',._'F1�i`�sph, �/w <br />`� M <br />? L2O � <br />,y-�"� <br />7 <br />� <br />Lcmhr.n� Ave <br />R D' �r�w <br />DRIVEWAY SECTION <br />NO SCpLE <br />�.-- Z 9 ' ---� <br />� +I�� LIP / I <br />30" _ _�30" <br />COPY OF THIS APPLICATIO�: TO I <br />BE POST[D ON JO�SITE. � <br />CAL� l.-tJGINEERING DEPT.259�8871 �� <br />L24 HOURS fiE'rORE_CONSTRUCTiONI <br />CHECK LIST <br />Water Valve <br />Dreinage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />Remarks <br />� Note: Original to Customer <br />� coP� �o F�i� 1 n A 1/1 <br />1 Copy to Inspector <br />..• �.,. <br />Ail�:y <br />p,. „.,, „ ti,, l The undersigned owner hereby agrees to hold and <br />�����, �� � save harmless the City of Everett from any and all <br />claims for damages that may arise because of inst:illa- <br />rion and maintenance of the improvemen, hereto <br />a�plied �or and further agrees to remove same upon <br />notice From the City and to replace public property <br />amage thereb(�` / � <br />�� <br />ure of Applicant <br />��.'� G 9 .� • <br />Address <br />�� � - G�L � <br />4��r`) <br />� <br />Date <br />% � �G�. �/�7(�. <br />cee ' � , �,. �,. - <br />;,�-r���' —�T�j <br />Approved by ' •L���/'//�/1��/ / <br />�dc! 7 ,d <br />Date Approved <br />