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_ <br /> � ' <br /> � <br /> everetl <br /> APPLICATION FOR PIGHT-OF-WAY USE�pERMIT <br /> �,�,�+ 9 �� 11069 <br /> e 6 ��'.���'F`' '� � '.� � <br /> CITY ENGINEERS � � <br /> EVERETT,WASHINGT(1N I � PERMITN0. � �137�� <br /> The Under igned f/����,/.li�c�k��,C� l7,�• �I CtL7'���F��KF I ✓:��"i/ Tl��T"- 1— <br /> Hereby applies for permission to .S� c '� � � p .� ' <br /> At the following location 5 J J 7 I%J v�L r.'� ;:. i-� i;% <br /> SKETCH <br /> � (Work to be done) ��, <br /> , S t i- /-�%%F)(.H r�D , 'i <br /> ' <br /> I <br /> I <br /> I <br /> I <br /> ' I <br /> I <br /> ORIVEwaY SECTION The undersigned owner hereby agrees to hold and <br /> NO SCa�E save harmlcss the City of Everett from any and all <br /> � -� claims for damages that may arise because of installa� <br /> � +i'� LIP tion .nd maintenancc of the improvement hereto <br /> applied for and further agrees to remove same upon <br /> �3o+.__ �3-�-� notice (r m the Ciry and to repla e public propert � <br /> da a thereby. <br /> G : !. ' � <br /> , Signature ot Applic�n� � � � , <br /> p•j �UC ; .L�F�IX/)7nd�f -�/�/' <br /> ICOPY�GF THIS APPIfC m� ION?Pj � Addr t / � � <br /> BE POSTED ON JOBSITE. -- -:- ,-��(. !� ,F� 1� �J7- •�j�C(� <br /> CALLFNGWEERINGDEPT. 259-8811 TelephoneNum ber <br /> /� lI (a <br /> I2�1 hIOUNS E3[FOHE CONSTRUCTION� Dam <br /> i <br /> CHECK LIST Fee �; � � <br /> Water Valve VDept. Approvals <br /> Drainage i, �9 <br /> Curb &Gutter Engineers_L�., i' - <br /> Sidewalk 6 � <br /> Water <br /> Street <br /> . Communications <br /> Inspector's Signature Traffic <br /> Planning <br /> _� <br /> Remarks <br /> � n <br /> Note: Original to Cus(omer � ' <br /> , �oPv �a F,�� 110 6 9 , . __, <br /> 1 Copy to Inspecror Approved by , - �—� <br /> .l��.�_ ,, ' ��f <br /> � Date Approved <br /> �� / . � C� � <br /> I ` <br /> -�----_.. . <br />