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ArPLICATlO� �OR RIGHT-OF-WAY USE PFRMIT
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<br /> CITY ENGWEE'iR5 �
<br /> [VERETT,WASHINI�TON PfRMITNO. �.6" Z 7I
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<br /> TheUndersigned ���/%_. � ,�� _ ____
<br /> Hereby applies for permission to (���•,<ti u;f , :,S � r�snh�lt V�. ��/ -
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<br /> At the following location %� / 7 ,�/� l7✓�
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<br /> DRrvEWaY SECTiON The undersi�ned owner hereby agrees to hold and ��,
<br /> NO SCALE save harmless the City of Everetr from any and all
<br /> f'—'— —`� claims for damages that may arise because of installa�
<br /> I" LIP tion and maintenance of the improvement hereto
<br /> applied for and further agrees to remove same upon
<br /> 30'� _ __�30"�I notice from i y a d to replace public property
<br /> damaye�:`�i .
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<br /> ' S�r�.�2tcre of Applicant �
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<br /> � COPY OF THIS APPLICATIOh: l"O Address
<br /> , BE POSTED OPJ JOE3SITE. �Ut�L �!�• ���.J�
<br /> CALL ENGIP'EERING DEPT. 259�8811 Telephone Num6er
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<br /> � 24 HOURS BEPORE CdfdSTRUCi�ION Date �� �/� G �'�.
<br /> � � „�, , ��L� �c� —I�
<br /> CHECK LIST Fee
<br /> Water Valve Dept. ApproValS,
<br /> Drainage � -� r
<br /> Curb&Gutter Engineers � � ii.+�� • ii �'�
<br /> Sidewalk Wate . = �^
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<br /> _ ,a,r,.� S[reet �� 7 � � '�a/�� �
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<br /> p�����_� � _._. �,r. .,. Communications:�',.��i'L i...,.-� -::���..,� .
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<br /> '� Ins t r i nature Traffic
<br /> �te �i � Planning
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<br /> ��=zl�'rie�•�a�-� C ..i� l/J*'7Tt���l .
<br /> Remarks
<br /> Notc: Original [o Customer
<br /> i Copy to Filc � (�;�
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<br /> 1 Copy to Inspector � Approved by �
<br /> Datc Approved
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