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APf`LICATION FOR RIGHT•OF•WAY USE PERMIT <br /> evcrett <br /> � �0946 <br /> CITY ENGINEERS �� <br /> EVERETT, WASHINGTON PERMIT N0. ��_ 33I_ <br /> � The Undersigned ����/-5 � � � ��� �- '. <br /> Hereby applies for permission to C O iy S T(Z v �T � �'�j 01��.( � 1 r � 1 � t�� � <br /> I At the following location �� — I � � <br /> ' � � 5 3 �G , 23�0" � <br /> SKETCH <br /> I (Work m be done) � ��S�p ' <br /> � � • � � �� ', <br /> , � �?/�'� ti I <br /> ; /o" I <br /> i C ohiCj<(;` <br /> ! �►Jr-_w,�� <br /> i� —_�` <br /> ; � <br /> , <br /> i f�hl F ►- 1� I N Cs , <br /> i <br /> ,� DRIVEWAY SEC710N The undersigned owner hereby ag ees to hold and � <br /> � NO SCALE save harmless the Ciry of Evere[t from any and all <br /> � � claims for damages that may arise because of installa� '�' <br /> ; �i' LIP � tion�nd maintenance of the improvement herero , <br /> applied fur and further ac�rees to remove same upon � <br /> , I 30" �— I 30" � <br /> f"��--�-- � - ----�-�-�1'-� no[ice (rom the Ci d ro rep:,.ce blic property � <br /> '�, damaged thcre6y. ��. <br /> � Signamre of Appl cai �� � '�, <br /> / � F S � , <br /> I i:OPY OF THIS i+PI'LIGATIOid 1-O � Address , ` <br /> BE POSTED Ofv JOBSITE. ��=�+I- G �/ U G . I�(j . <br /> ' Telephone Number �� / � �/� � <br /> I CALL ENGINEERI��G DEPT. 259-8611 � b <br /> I � 2.: ;-;� 'Uf;.S i3f=FGR[ COiJSTRUCTIOPI� Da[e • <br /> C� l a_ � � //, s� <br /> CHECK LIST Fee f., <br /> Water valve Dept. pprovals����/'� <br /> Draina9e �-= . <br /> Curb& Gutter Engineers �/�i�� � � <br /> Sidewalk <br /> Water <br /> Strect <br /> _ Communications <br /> Inspector's Signature Traffic <br /> Planning <br /> a[�e <br /> Remarks . _ .. <br /> Note: Original to Custumer . , <br /> 1 Copy to File � �Q(� 6 -,.��- <br /> , 1 Copy to Inspector , •o�" � � . - Approved by <br /> -. `--Y.. . � . <br /> � � Date Approved <br />