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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> everen _ �0 6 C� <br /> � J J i <br /> CITY ENGINEERS � <br /> EVERETT,WASHINGTON PERMIT N0. �� 7— ��/ � � <br /> The Undersigned ,.,� � �5 c�c' %,=1 �� ! <br /> � t <br /> � Hereby aoplies for pertnission to f'j ' -'� j� r�t i���✓ �.�i� r/-+ a%=v., S/��✓ - P�'a d /Sn — ��i <br /> � <br /> . At the following loca[ion�V � P ��7 .i-_'.2 1= vr R,=--- ��ui_ � f r%�r.',r 5 <br /> I l aJ i ��/ ',� '� ���/t_ <br /> SKETCH i <br /> (Work to be done) � � <br /> i Sj i: ,'� 7711� �1 '-�r7 �, <br /> ; <br /> � <br /> III <br /> I <br /> � <br /> I <br /> i I <br /> I� <br /> I � <br /> I <br /> i <br /> � ORIVEWAv SECTION The under,igned owner hereby agrees to hold and �I <br /> NO SCALE .'•ave harmless the City of Everett from any and all i <br /> �-- —��� claims for damages that may arise bacause of installa� <br /> . �" L�P tion and maintenance of the improvement here[o I <br /> ! applied for and further agrees to remove same upon , <br /> ; �30';,�__ ___.__�30'� notice from the City and to replace public property i <br /> �, damaged the �' i � /� <br /> I� ___�/` � ,f `u- /�` 4` I, <br /> �. Signam o (S�cant <br /> i �� � <br /> —, i ,��-�� <br /> � COPY OF THIS APPLICATIOfJ TO I Address/ � � � <br /> �� BE POSTED ON J06SITE. i ��/�CGvy l/Ql����X/ �{��• �Z7J I <br /> CA;_L ENGINEERING DEPT. 259�8811 I Te ephone Number I <br /> �FYSt - /bZ / <br /> �i '4 HGURS 6EFORE CONSTHUCTION� Date ' <br /> , - ---- -- - -- -- � - Z.3 - 7'7 i <br /> �' CHECK LIST Fee h/B (=1:�- �I <br /> I Water Valve Dept. Approva� <br /> '�. Urainage '/ � <br /> Curb&Gutter Engineers ��!'!� . �%� ' <br /> . Sidewalk Water <br /> 'i <br /> Sireet ' <br /> Communications � <br /> Inspector's Signature Tra(fic � <br /> Planning <br /> ate <br /> Remarks � - � <br /> i <br /> Note: Originai lo Customer p t' � ��, <br /> lconvtoFile 1��J5J 'I <br /> 1 Copy to Inspecmr Approved by , <br /> Date Approved ' <br />