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cvcrett <br />� <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />1�1�$L <br />PERMIT NO.���_ <br />The Undersigned /' / � � r �— _ il <br />Hereby applies for permission to �'r,�, r t� ,:- ,� , c' I� .; /��,y� � � a ��� <br />At the following location UZ 2 D f-/�i i �p�i�/�, , �_� /�",. � <br />—� -- <br />(Work to be done) <br />� <br />� <br />� <br />NO SCALF. <br />r - - -� <br />�'� LIP <br />�.3�� _ —_ _—��'1 <br />CGPY OF 1�HIS APPLICATIOiJ TO '' <br />BE POSTEG ON JOBSITE. <br />CALL BP2GINE[RING DEPT. 259-gp17'� <br />..: `�;�1::H5 ['Ef-i)ftE f.ONSTRUCiIONI <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Guttcr <br />Sidewalk <br />Inspeclor's Signature <br />Note: Ori9inal m Customer <br />,co„YtoF�i� 1 n�iR? <br />1 Copy to Incprctor " <br />� I <br />� I <br />i <br />,! � <br />� <br />S "j <br />� <br />i' <br />Ut— <br />I <br />..._ _...._....y..._...,..��,:� �����..y ay��co w u��u eiid �i. . <br />save harmless �he City of Everett from any and all � � <br />claims for damages that may arise because of installa� , <br />tion and maintenance m the improvement hereto <br />y� " ��t � �'� F� applied �or and further agiees to remove same upon .� <br />notice from ihe City and to replace publio-property <br />damaged theieby. . � _ <br />Signature of Applicant j . <br />� _ <br />Telephone Number <br />��� � <br />� � .; ,, � ,;��'�._ <br />Fee <br />Dept. Approvals <br />i <br />Engineers_.�- �G, ::,:�,__ <br />Water �'�� .. ���$�_�_ , � ' .. <br />. --:�==� �. <br />Communications <br />Plann!ng_ <br />� f z—� �/�'" �-_,_,_ /— T � <br />v i <br />Approved by <br />ba�c APp�ovcd <br />� <br />