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� � � APPLICATION FOR RIGHT-OP•WAY USE PERf�911' <br /> cvcrcll <br /> �``.��� 1�05 �r <br /> � . <br /> CI''Y [NGINE[RS . � � � • <br /> EJERETI'.VlASFIIPIGTON P�RMIT N0. � �/�.P� ' <br /> 'fhe Undcrsi9ned��� �/�//� ��Qstt Y S <br /> Here6y applies for parmission to . d�T�'cl G��_ ?-.3� i�SF'//Y � T , <br /> At the following Iocation��0 7 %F}5 f �LF/y JJ�2 t,o�� • S/fal'T p�.�-T '. <br /> />o'!-� � <br /> SKETCH — � <br /> � ��Work to bc done) <br /> . . � <br /> . . -sEF R-rrR-ci�rE� <br /> �. <br /> . ' . � I . <br /> . �, <br /> . . . . D.� 7�0 '�h�r��� � <br /> � .f <br /> .�� �//�� • . � <br /> . �- , <br /> . , . . � <br /> . . . i. <br /> , - � • � � <br /> � <br /> . • . I <br /> DRrvEWAY SECTION � The undersigned ownen c�reby agrees to hold and <br /> NG SCALE sa�e harmlcss the Ciry of Everett from any and all � <br /> � � —� � - elaims for damage, that may arise beeause of installa• � <br /> +I" Lla —� . tion and m=inicnznce of the improvement hereto ! <br /> applied for and fuyr tie a rees to removc same upon <br /> 30" I 30" � g jx fro t r,�City and lo replace oublic property <br /> � . � 'a[ga5ed thereby. <br /> . . c L✓iyii�/ i;'ON1i=S �y� <br /> � ' • . 5 nature o( pplicant � <br /> COPY OF TIiIS APPLICATION TO Address ��/ ^N� /G $c�r>Gf' <br /> B[POSTED ON J06SIT[. �j(�'L _ Z-O/L l ��77 <br /> CALL ENGINEERING DEPI'. 259�8817 • ' Telephonc Numbcr <br /> 24 HOURS E3EFORE CONSTRUCTION Date Q G% ti S �� <br /> CiIECKLIST fec ���� /j�/ /����� ' <br /> Ora na c Ivc . �pe ^ rovals 7 <br /> 9 �PP <br /> Curb &G�ttcr . ' . � . Enpioe¢rs � ✓/ , .� ✓ <br /> Sidcw.lk � . . � � �tiatcr <br /> ' • .Strect <br /> � � Communications <br /> Inspectur's Signaturc ' � Traflic <br /> Plannin9 <br /> �IL � <br /> Rcmmks � - _. <br /> NoW: Oripin,l to Customcr q —��— <br /> 1 Cnpy to Fdc � .L �) � ---- � <br /> 1 Copy tn In:puclor Apprnved 6y <br /> t)atn APPtorrrl "`— -- � <br />