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APPLICATION FOR RIGHT-OF-WAY USE PERMIT U <br /> e.eretl , �O 7 2 Q <br /> e � �� <br /> CITY ENGINEERS cL � <br /> , EVERETT,WASHINGTON PERMIT NO.�J � - 3 / <br /> TheUndersigned_ ���Jr' 1=r�%�" " -� i�� .�..� � t�.r , <br /> Hereby applies for permission to �' � �!'�� � � � `� /'�'�n+�� f ��f�-� ', <br /> �. At the following location �l 5/ l=Lpi�r t7✓-1 ��i� � <br /> SKETCH I�I <br /> �� (Work to be done) � <br /> ' SEc A7irr.i,��> � <br /> I <br /> I 1 i <br /> I ' <br /> � ' , <br /> � � I <br /> ,, <br /> � � <br /> I I <br /> � <br /> . I <br /> � � <br /> I <br /> , i <br /> I <br /> � <br /> ` I <br /> l� � <br /> � , <br /> i <br /> II� DRIVEWAv SEC710N The undersigned owner hereby agrees to hold and I <br /> �' NO SCALE save harmless the City of Everett from any and all <br /> i _� � <br /> i !._-- - claims for damages that may arise because of installa- �I <br /> �i r� �I" LIP tion and maintenance of the improvement hereto � <br /> i applied for and further agrees to remove same upon <br /> 30" _ 30�� notice the,City and to r��PPlace public proper[y � <br /> • damaged ereby. / ,,� -.Td^�ESrT°"Ks <br /> ., I � �). .. _G�� ( -�� TG.J£G SN L� <br /> �, ' ne of Ap licant / � <br /> � �, �`�,f.�—9—9 �f y�` <br /> � ' COPY OF THIS APPLICATION TO � Address � ` �--L �, <br /> ! - � �BE POSTeD ON JOBSITE. �SS- fi � -� �-/ I, <br /> Telephone Number <br /> �� CALI.. EP!GI^:[G;ING UL-PT. 259�8871 i , <br /> �, 24 HOURS ��FORf CONSTRUCTIOid� Date `,U � � � <br /> . --------- ------� / � �- .�� ' <br /> � CHECK LIST Fee <br /> ' Water Valve Dept. Approvals � <br /> ' Drainage � I <br /> i� CurL&Gutter Engineers <br /> I <br /> � SidewalS. Water � <br /> �I � Street , I <br /> 1 <br /> Communications <br /> �, nspeccor'sSi9nature Traffic I <br /> �� Planning <br /> ' ate �I <br /> �� Rtemarks '� <br /> I NQte: Original to Customer I', <br /> � 1 Copy to File � �7 2 8 <br /> � it 1 Copy [o Insper.tor Approved by <br /> ' t Date Approved <br /> —^r•�. <br />