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evcrctl <br />G1Y [NGWEEHS <br />EVER[TT�, WASHWGTON <br />APPLICATION FOR RIGNT•OF-WAY USEPERMIT � 112 7 <br />PERMIT N0._. %B _/�(� _. _ <br />Thc Undersigned _ /� [` �i • n c � >��J� �t ': //. �,,.. �- <br />Hcrdry applics for permission to . �-c^ n s�"h .- 2 ,2 S�' ���,, f G:-.. � � <br />JS �Q <'i ,4-it <br />i.! -- <br />At thc fullowin9location_�� G) $r) qJ /( (�•�/) 4, y� <br />-�/_... .__—_—_.__ _ __ <br />SK[TCH <br />(WorA to bc done) <br />_/ <br />,:,��s :.rL I'�1%nm�i /'C.. <br />✓. <br />� f+� S A/: �,..¢ �' �� <br />7 �-N R�/� <br />DRIVEWAY SECTION <br />NO SCCl.E <br />�_ ( I" LIP —�1 <br />� <br />4..3���� ....T— —__'_-.--.4+30 f <br />-i <br />' COPY OF THIS APPLICATION TO <br />� QE POSTED ON JD851TE. <br />I CALL ENGINEERING DEPT.259�8871 <br />� 24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Side�•:alk � <br />Inspecror s Signature <br />�ate <br />Rrmarks <br />11127 <br />cusroman <br />L <br />The undersigned owner hereby agrees to hoid and <br />save harmless the City of Everett from any and all <br />claims tor dama9es that may arise because of installa• <br />tion and maintenance of the improvement hereto <br />applied for and further agrees to remove samc upon <br />�iotice from the City and to replace public property <br />darpaged therebK: . � <br />-�k��L� �t.���.-r�-- <br />Signaiure of Appiicant <br />l�2/f� F.... . �t�.. �Lr,. �C��G'� <br />Addre:s <br />3 r`:f — 7 7[^� <br />Telephone Number <br />;(_-/l✓�?�, <br />Date <br />Dept. Approvals <br />Communications <br />Approved by <br />Date Approved <br />