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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />evc,clt L 0 4 3 3 � <br />CITY ENGINEERS / <br />EVERETT, WASHINGTON PERMIT NO. 71— 7I <br />The Undersigned Forr:f !'nr/,, -S�vrnt/l %fir, , AelyFn/r"f Church <br />Hereby applies for permission to _ C do s fr rt ei 30 r t^r, r✓f 0 t oh n zt on r� <br />c�F - Lt/fry <br />—�—� <br />At the following location 4 IS 2 Y& r/ P r c t A v e= ,V <br />(Work to be done) <br />II <br />MI <br />4 <br />•. C/ <br />y <br />arsz <br />� <br />rl <br />Nc3Tc, <br />g, <br />Wi37�h' /YJf"TE« <br />V) <br />GF c Tv ff'� <br />NEjY 6/�Ap <br />cr n w r, <br />clew Cc frl, Lac sin L sc wer perm,l reyui red <br />Pole FO(^ <br />Feder-cr/ Ave. <br />DRIVEWAY SECTION <br />NO SCALE <br />30' <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />GALL ENGINEERING DEPT. 259-8811 <br />24 HOURS BEFORE CONSTRUCTION <br />utter <br />Ins "`or'sSignature <br />7 <br />—Date <br />Do hloi 3co/e <br />4GS'rf <br />DTJr�/`uG <br />Remarks "�— i2/,1rJ/C �l�� �i y /� j%�%•i <br />Note: Original to Customer <br />1 Copy to File 3 <br />1 Copy to Inspector <br />V <br />C <br />P�L <br />T_ <br />The undersigned owner hereby agrees to he Id and <br />save harmless the City of Everett from any tnd all <br />claims for damages that may arise because of installa- <br />tion and maintenance of the improvement hereto <br />applied for and further agrees to remove same upon <br />notice from the City and to replace public plop W <br />damage t ;reb�y..Jc l 447 <br />Signature olantr <br />Address ylaJ of <br />Teleph'o�ne� er' � <br />'--= N urn�'T 9 7 <br />Fee <br />Dept pr v s <br />Engineer <br />Water RS C Ale <br />Street < <br />Com muniration _ <br />Traffic <br />Planning <br />PW t/' <br />Approved by <br />—T <br />Date Approved <br />