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APPLICATlON FOR RIGHT-OF•WAY USE PERMIT
<br /> evcrett
<br /> � 10638
<br /> � . CITY ENGINEERS
<br /> ' EVERETT, WASHINGTON PERMITNO.
<br /> � The Undersigned y �
<br /> , Hereby applies for peimission to ' �% . r � r, .,
<br /> � A[the followirg loca[ion �' : ' �� ' ' ! -� - - �
<br /> SKETCH
<br /> � (Work to be done) . -
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<br /> ORIVEN'1Y SEC7i0N The undersigned owner hereby agrees to hold and '
<br /> � NO SCaLE save harmless the City of Ev�rett trom any and ail
<br /> � � claims for damages that may arise because of installa� �
<br /> i" LiP tion and maintenance of the �mprovemznt hereto
<br /> applied for and tunher agrees to remove same upon '
<br /> 30" I 30" noti�e from the City and to replace public properry
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<br /> damaged thereby. �.'. . �-' ,.
<br /> �� , , y=J�=.,� ,,,�:
<br /> Sign Uta rC of Applicant"� . _ --`�.,
<br /> . .-----__---- -. ..-- --i � c; -i //? !:"6•/F��� .-ii.=,-.�. � .�
<br /> . COPY OF THIS APPLICATION TO I � Address � �-
<br /> BE P.OSTED ON JOBSITE. ��' �, � - 7`-j�lp � -
<br /> � �. CALL ENGINEFqI;JG DEPT. 259-A81 I I TelephoneNumber ��
<br /> . . . ._ /! � � 7�. i
<br /> � iIOUR:; [36FORE CO3''J�TRUCTIOfQ� Date
<br /> � � CHeCK LIST �� � 1 + �
<br /> Fee �
<br /> Water valvc Dept. l�pprovals
<br /> Drainage
<br /> Cur6&Gutter Engineers� %'' <:`�� . � / ! / �
<br /> Sidewalk
<br /> Wa[er
<br /> Street
<br /> _ � Communications '
<br /> Inspector's Signature Traitic �
<br /> _ Planoing � �
<br /> �ate � � i - .7 � . .
<br /> � - . i
<br /> Remarks
<br /> �
<br /> Note: Oripinal to Customer �,
<br /> i cor,v io F�i� 1 (1�� �
<br /> 7 Cnpy to Inspector Approved 6y '
<br /> Datc Approved
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