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� � - cverc�t � <br />�. <br />� CITY ENGINEERS <br />FVERETi. WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USC PERMIT ,-.� � U176 <br />PERMIT NO. �� "� � <br />The Undersigned �' i-; � � � �� ' � � ' � " � ' � " <br />Hereby applies for permission to C��-SrQUCT �s� � C�/��C��T� D�/VF. L✓HY <br />At the follo�.ving location /3 3 G /�7I7D2DNG9 AVE <br />(Work to be done) <br />l5' <br />5' <br />I 33 � <br />�_ NE�v D,eivE�vHv <br />ia • �nsE�ir�vT <br />�UTILIT/FS � NGCESS� <br />-EXISTING <br />CUP.B <br />I <br />DR!VEWAY SECTION <br />NO SCA <br />�---- — /5 ---_ _--{ <br />- I•' LIP <br />�'� ----f�=-- 30���� <br />-- -- - —._ ____.. __-- --� <br />COPY OF THIS AFPLICFlTIGN TO <br />BE POSTGD ON J06SITE-. <br />CALL EVGW[ERING DEPT. 259-8811 <br />i�' IiOUfiS f3[FORI� CONSTRUCTION <br />� _ _ ----. <br />CHECK �IST <br />Water Valve <br />Drainaye <br />Curb & Gutter <br />Sidewalk <br />`� t-�/! <br />� �:;� l �(. <br />� , �. <br />Inspector's SignaW re <br />p�E�� CONC�E7E D2�VEIn/FY <br />� � <br />. � � , i � � <br />atlie � <br />� i.� i i ' �1., �. �:� ���: r <br />' ���� ��y'i°�'i�. l� � rL� . .- <br />Remarks � <br />Note: Original to Custor �r n <br />t conY to File 1`�' i_ � 6 <br />i Copy to Inspector <br />�Y1�� <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and all <br />claims for dama9es that may arise because of installa� <br />tion and maintenance of the improvement here[o <br />applied for and turther agrees to remove same upon <br />notice from the Ciry and to replace public proparty <br />�` <br />�maged thereby. � � <br />�f o� �• ����._� <br />Signatur Applicant <br />7? 1 A �G �.� • '�. � _ <br />Address <br />. _\ ��� C. Cr� N^ \� �/�:��ir) <br />Telephone Number <br />�C�� - :�I')� �/ <br />Date <br />��� •��' i� , s �S� <br />Fe��� � . S' ZL'-7j� <br />�ept. Approvals <br />�c, �—.�: —7.� <br />� <br />n�P�°'�,�, y° , -3-7 <br />�4'`... �!�._ llC.iZ,�, .v'✓ S . r <br />� � <br />Date Approved <br />