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APPUC�TION FOR RIGHT-OF-WAY USE PERMIT q <br /> , '. everetl � �31� <br /> � � <br /> CITY ENGINEERS 7i' Z 3 I <br /> � <br /> EVERETT.WASHINGTON PERMIT N0. <br /> � <br /> The Undersigned ������ " "�� �Q f'' ` -f � <br /> Hereby applies tor permission to l� N��.!�j' /] I7�rl'����f'- J �4� '� '<. ��Y-�--- II <br /> � <br /> At the foilowing location '��(� y ��.F» ��LL—{'�� _ � , — '� <br /> \ <br /> SKETCH <br /> (Work to be done) � � ��A , ,,��,� � . -. �, ' <br /> , ���� � � � . �, <br /> \ i <br /> �� ' . �.� I <br /> , �.. �:. <br /> ,� , <br /> ' � Ci �: /y,Gq�'��1�1' , <br /> . �.✓'v� ll_ <br /> ✓ <br /> I � <br /> I <br /> I . <br /> II <br /> � DRivEwaY SEC7i0N . The undersigned owner hereby agrees to hoid and j <br /> NO SCaIE save harmless the City of Everett from any and all �. <br /> ----� ciaims tor damag^s that may a�ise because of installa� , <br /> T ' LI� tiun and maintenance of rhe improvement here[o ��, <br /> � �L applied for and further agiees to remove same upon <br /> �30 —,.�.3� notice from the C�ty and te replace public property I �,. <br /> —� damage thereby. � <br /> � �' <br /> . � a�.,:�:�i <br /> Signature of Appi/ican[ �� <br /> . . . ?_i i� �l,e'�f 'i..iA� , <br /> . �COPY OF THIS APPLICATION TO Address .� �, <br /> BE POSTED ON JOBSITE. . -� �I �l� � � � 7 � � <br /> , �� Telephone Number � <br /> CALLEPIGWGERINGDEP_Lt59�8677 ;I _ I <br /> �` Date /� <br /> ?4110URSI;fFORECON57RUCTION� � ��y?� !�`� � I��I �� <br /> CHECK LIST Fee ���—� � � �� <br /> V/ater Valve . Dept. Appr va15 �, <br /> �� <br /> Gurb &Gutter Engineers � '. <br /> Sidewalk Waler � <br /> ��. Stree[ � <br /> Cornmunications � <br /> I rspecror's Signalure Tratfic <br /> Planning <br /> � — <br /> —6ite <br /> Rcmarks , �-�.. <br /> Note: Original to Customer � <br /> i conv co r-�ie �.0 g 19 <br /> 1 Copy to Inspector Approved by <br /> Datc Approved <br />