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�----� <br /> ' cvcrcu A�'�'CICATION POR RIGHT-OFWAY USC• PFRfv1IT � <br /> '� �� 11012 ; <br /> CITY GNGIN@ERS I <br /> EV[RETT, WASHINGTON � �' <br /> PERc41TN0._ '.•' % I <br /> The Undcrsi9ned�1� �1jr N^� rj��,� �� .� <br /> Hrreby applics tor pennission to_ �l !� ' T r/ � � � �--• <br /> w <br /> ------�_ <br /> I <br /> At the tollo�ving loc�,ion_ Z S�- /��� �' F���, r� <br /> , � <br /> SK[TCH <br /> (Work to 6��done� � <br /> SEc �.�.-r-rAcflr�� � <br /> i <br /> � <br /> � � <br /> Q�. ; <br /> � . <br /> . � <br /> . � <br /> . �� <br /> DRIVEwAY SECTION The undersigned owner hereby agrees to hold and <br /> ,F. NO SCALE save harm!ess the City of Evcrett irom any and all � <br /> I ----- � claims tor damages Ihat may arisc 6ecausc of installa• <br /> I" UP . <br /> � tion and mainienancc of the improvement herero <br /> �..3Q�_. �--_ _�30�� � applicd for and further a9mes to remove same upon �; , <br /> . —�'� notice irom the City and to replace public property <br /> dama d thereby, � <br /> y / (� ; <br /> �L!'- ��� '-y-1--��� "��'1'l.'l0 !i <br /> Signaturc�Apphcant � r <br /> COPY OF THIS APPLICATION TO Addres�r 2�3�����Y I �` <br /> BE POSTED ON JOBSITE. • _�j7 � �,�C� <br /> CALL [NGINEERING DEPT. 259�6811 Tclephone Numbcr k <br /> 9� IS' � 'l7 � <br /> 24 FIOURS �EFORE CONSTRUCTION Date <br /> CHECK LIS1' <br /> Watnr Valvc , Fec /..- <br /> � Draina9c . i Dept. Apptov�ls <br /> Curb&Guiter G' / � l % <br /> Sidewalk � Enginccrs � ���-;� .,-•' <br /> � . Walcr ' <br /> Street <br /> Inspe[tor s 5ignaturc Communications <br /> 7raftic <br /> Planning <br /> �rlc <br /> Hemarks • � <br /> Notc� Oric�inal to Cusromer � <br /> ' c°nv `°F''� 11012 <br /> , 1 copy to In:pector APProved by <br /> .,_., .--- -' <br />