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ev�,�etl <br />U <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />APPLICATION FOR RIGHT•OF-WAY USE PERMIT <br />�Cl856 <br />PEftR11TN0. "�%%��-3� <br />� <br />TheUndersigned_(' �+� � �"=+l�i+� r �� �'� <br />Hereby applies for permission to r0 n� � r.Z�t_=�� -' � J"'��'t�'� � ti li � i <br />At the following Iocation �� 0�f— �O�/�t� ��E p� <br />SKElCH <br />(Work to be done) <br />SE_ F� `fl' �f! � ` <br />F � � r � ,� .;�1"•,; <br />� <br />" <br />� �(`� ��37 F <br />�' ��� �•v }hY,J . <br />x s <br />_�;� �..'� . <br />rM <br />DRIVEWAY SECTION <br />NO SCALE <br />� � <br />� ��� LIP� <br />30" �30�� <br />COPY OF THIS APPLICATION ��O <br />6E POSTED ON JOBSITE. i <br />C;;LL ENGINGERING DEPT. 259�3fl1 I � <br />74 ViOURS EEf-ORE CONSTRUCTIONi <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter f�l LG, I T� <br />Sidewalk � <br />�: <br />�� { <br />Inspector's Signature <br />Notc: Original to Customer <br />1 Copy to File a_ o€i 5 6 <br />1 Copy to tnspector <br />The undersigned owner hereby agrees to hold and I <br />savc harmless the City of Everett from any and all I <br />claims tor damages that may arise because of installa- ��� <br />tion and maintenance oF the improvement hereto � <br />applied for and further agrees to remove same upon �� <br />notice from the City and t eplace public property j <br />"�751rta ed thereby. <br />Si ure of licant � <br />A dress 'ry <br />'��S-�� �S � <br />Telephone Number ' <br />�� - I 7 -� � _ <br />Date /�L_, �� � <br />� � <br />Fee Y " ' <br />Dept. Approvals � <br />Engineers����.� r �' <br />Ccmmunications <br />Plann <br />Appruved by <br />Date Approved <br />