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� APPLI�ATION FOR RIGHT-OF-WA`( USE PERMIT <br /> �everetl .� _ � -'.-_-..,. <br /> � (\r �Q��� <br /> •".�,.�- <br /> CITY ENGWEERS /�✓`'��"'��� <br /> EVERETT,WASHINGTON PEFMITNO. � � ', <br /> The Underslgned - - \ . <br /> Hereby applies for permission to - , � . � � , �, <br /> At the following location �; � , � <br /> SK[TCH —_ '�. <br /> (Work to be done) �, <br /> �}'��,C. vV.u--Tz L�na� <br /> --__ _ - - � <br /> � „ <br /> ___—_ � �Ew�.c�7. <br /> I <br /> .� .— -- � `� _ _ _ _ <br /> _. <br /> ` ; �� I �-7, � <br /> J ? ! � }vJ,�� � <br /> i � <br /> 1 � <br /> ; r <br /> 1 Zl�.v i� <br /> � �� <br /> � <br /> <S�>c,c; o*� <br /> � <br /> . _ - --- ---- <br /> �� � <br /> DRIVEWAY SECTION �The undersiyned owi�er hereby agrees to hold and � <br /> �rv0 SCALE save harmles��the Ciry of Everett from any and all <br /> -- - � claims fordamages th.t may arise because of installa- ' <br /> +f� LIP � tion and maintenance of the improvement hereto �� , <br /> ��p�•� __ _ I 30,� � applied for and further�grees to remove same upon �; <br /> -'t' �'1 notire from the City and to replace public property �� <br /> da�a¢�d ttie�eby. . <br /> Si�gnature f�App" icant �. <br /> �----------- - — . _ _._ ._ . -��2.c°r � �=l + � - l(�L��� � <br /> I COPY OF THIS Ar?LICATION TO ��� Address . _ <br /> f3F POSTED ON JOBSITE. , ��--- ,_ C; j- ',,.( _��.�,.� <br /> �. C��I. I_ �M11GI fJ[EHING DEPT. 25�J-f3II 1 I ' Telephone Num�ier <br /> ' ?; hI�URS [3EPORE CO�JS7"RUCTIOPJ' Date — <br /> � - -- �----- ' �(J .7 �� / . <br /> CHECK LIST �� ��'' ' �—�-/�j <br /> Water Valvc , f Fee � � <br /> Drainaqe N, �,�,�,�!�• �•T;7 Dept. Approvals <br /> Curb&Gutter ti.F,��" `�� `:'" •`°'- � �j/ � � . <br /> �� En9ineers_ �';� <br /> Sidewalk ------ <br /> � � -' Watcr__,_ � <br /> Strcet <br /> Ccmmunications <br /> Inspecter's Signa[ure — � <br /> TraTfir. <br /> Pianning � � <br /> at� c — — — <br /> Remaiics � �� � <br /> Notc: Original to Customer . <br /> ' c°nv '° F:'� 10705 <br /> 7 Copy to Inspr.ctor App�oved by <br /> Datc Approved <br />