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APPLICATION FOR RIGHT-OF-WAY USE PERMIT
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<br /> CITY ENGINEERS PERMIT N0. �,�I- �G/O
<br /> EVERETT,WASHINGTON �
<br /> The Undersigned=�-��"- i'�' '�� ' t'�'''Y' /� �,�� _• ,(��� �
<br /> � Herebyappliesforpermisiionto �' �� �t�''�� = �-'� c'"'`•�- � - �r- ' - '
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<br /> DRNEwav SEC ON / � ' The undersi9ned owner hereby agrees to hold and '
<br /> nl0 SCaL� � save harmless the City of Everett from any and all
<br /> � _ __-_-- ---..I . � claims for damages [hat may arise because of installa�
<br /> ' %� tion and maintenance of the improvement hereto
<br /> f' LI " applied for and further agrees to remove same upon
<br /> �3p� __ _��" %� nqtice from the City and to replace puhlic properry
<br /> ' ' d aged thereb�,/ �
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<br /> Sig aturc of Ap ican( �-� ` �
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<br /> Address
<br /> COPY OP THIS APPLICATION TO , 3 5�- I jGQ ,' 2� `I " � 7'�`I .
<br /> BE POSTED ON JOBSITE. i Telephone Nu b� � � ��4 �'��� +•�
<br /> CALL ENGINEERING DEPT.25&8671 ,� _� .
<br /> 24 HOURS 3EFORE COIJSTRUCTIOh.�� Date 2, ��- ,
<br /> -----.-. .-- /-� i _.�
<br /> CHECK LIST � Fce ,
<br /> Water Valve Dept. Approvals
<br /> Curb &Gutter Engineers l ' cr��- �.1�� » � i
<br /> Sidewa�k w�ter : J '� . ,� � '� " � -I s�,
<br /> Street_ , . , _ '
<br /> Communications
<br /> Inspector's5ignamre Traffic � � �
<br /> Planning
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<br /> ate
<br /> �-=�^—=--r= �
<br /> Remarks
<br /> Note: Original to Customer e
<br /> � 1 Copy to File �Q 6 Q 1 Approvgd hy� � �n
<br /> � 1 Copy to Inspecror � ��.,_ _
<br /> Date Approved
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