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APPLICATION FOR RIGHT•OF•WAY USE PERMIT �+f'i �
<br /> `°"�'� 1112 8 i''+- �
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<br /> CITY ENGINEERS
<br /> EVERETT,WqSHWGTON PERMIT N0. % "Y `�� /
<br /> The Undersigned 1 � ' � �
<br /> Here6y applies for permission to_,�� . � ,.� �. -.. .,. - . ��
<br /> At the following location % � ' � ,'' �',. , ..1 L
<br /> SKETCH
<br /> (Work to be done)
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<br /> DRrvEwav SEC7i0N The undersigned owner hereby agrees to hold and
<br /> {,,.._�NO SCAIE save harm�ess the Ci,ry of Everett from any and ail
<br /> I � � ciaims (or damages t�a[may arise because of install��
<br /> +I" LIP � tion and maintenance of the improvement herero
<br /> appiied for and furthar agrees to remove same upon
<br /> �,30'+__ _____. I 30 I notice from tl�a City and to replace public property
<br /> -�r. �.�
<br /> damay�d thereby.
<br /> Signature of Applicant .
<br /> � COPY OF THIS APPLICA�ION TO Address -
<br /> BE POSTED ON JOHS�TE. / � i/
<br /> �
<br /> Telephone Number ' -
<br /> CALL ENGINEERIIJG UEPT. 259�8811 - _ ��,. . U
<br /> 2; HOURS BEFORE CONSTRUCTION Date -
<br /> ,^.HECK LIST Fee�-.� -. �
<br /> Waror Val.•e "`� �_ "� � '
<br /> Dept. Approvals
<br /> � Drai� ,y., . . . J. I.
<br /> f.urb�it�°�.,•ter —� Englncefs ' ' � ' � :u� �; � � C!
<br /> Sidewalk -` -
<br /> Water_
<br /> � Street _
<br /> _ Communications
<br /> Inspecto S� nature —
<br /> Traffic_
<br /> ✓ �P/� � 7� Planning
<br /> at�
<br /> Remarks
<br /> 1 � i � � --� , I
<br /> , , � , _�,_ ,
<br /> Approved by ' 11 �
<br /> ii �- i �l�' .A-� � 1,-.., �(�� �
<br /> � �1� Date Approved 0
<br /> � INSPECTOR'SCOPt ;I �� ���^��
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