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APPLICAI iON FOR RIGHT•OF-WAY USF f E�.��� i <br /> c.crett r`;l � G('? . <br /> � : J U <br /> CI7Y ENGINEERS � ��� i � �i <br /> EVEHf_�R', WASHING70N , PERMIT N0._ _ <br /> The Undersigned_�,:��2 r � �� - ,-!t T a� �.� .i _ �, <br /> Herc�y applies for permission to�. � - '�[.� =1 2 � � .) s vi'�l� "" /�l �- <br /> At the following location �/ �}� a.�v,.i r v _ ___ <br /> i SKETCH <br /> �. (Work to be donel � <br /> `,�: <br /> 5E£ AiI ��C H c�� <br /> I <br /> I <br /> I <br /> i Ii <br /> i <br /> i � <br /> I <br /> I <br /> I <br /> D�iVEwnY SECiION The undersigned owner hereby agree:to hold and <br /> NU :Ca�E save harmless the City of Everett from any and all <br /> � I.-- -----I claims for damages that may arise because oF installa• � <br /> �" iv tion and maintenance of the improvement hereto <br /> � ���. c —�- � applied for and further agrees to remove same upon <br /> �30�„� _�_.. .. . ___�30" notice from the Ciry and to replace pu�lic properry <br /> dam ed h <br /> �.� ���������� <br /> Siy�a}ure of Applicant <br /> �s'�.Z�- Gr�CVL,G.e�O�/C• <br /> ' COPY OF THIS APPLICNTION TO—� Address � <br /> I BE POSTED ON JOBSITE. E� ltJ.�1• �`F20 3 <br /> � Teleph e Number <br /> CALI ENGINEERING DEPT. 259-8811 • �,✓ ��� zSZ- S(o'7/ . <br /> �. II�!UHS '�Ff-GR[ CONSTRUCT�ON /�V C1� Date �_�_ 77 , <br /> . i . , . . ..-. _ . -------- ' .1 n <br /> CHECY. LIST /�� t�' o�p� Fee �` .5, � <br /> Water Valvc � \i6 Dept. A proval5 <br /> Drainage � /� "f' <br /> � Curb&Gutter Engineers � — <br /> Sidewalk Water _ � <br /> Stree[ _ <br /> Communications <br /> Inspector's Signature Traffic . <br /> . Planning �. <br /> atc — <br /> a_ <br /> Remarks <br /> No:e: Original to Customer <br /> 7 CopY to File 'l n C�2 O <br /> 1 Capy to Inspecror Approved by �. <br /> Date Approved <br />