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ereren APPLICATION FG�� RIGHT-0�•WAY USE PERMIT <br /> : e , � s��o8 <br /> CITY ENGINEERS �l //� � <br /> EVERETT,WASHINGTON . PEflMITNO. � � , <br /> TheUndersigned �r��T/7/✓/�_.�-��Y'7CNr/2 <br /> Hereby applies for permission to__4 n NST,�CT �7- - /7� �i>�/e�T� f��W 'S <br /> � <br /> A:the following location�o/ �� �',..�lU'��J 17 IJ,.� .__ <br /> SICETCH <br /> (VJork to be done) . j � <br /> i <br /> , �r� I <br /> <.',� r-? � ,-���;•_- � � <br /> � <br /> I <br /> i <br /> � <br /> �I <br /> � <br /> i <br /> I <br /> i <br /> i <br /> Ef <br /> i <br /> �i <br /> � <br /> D�twEwav SECT!Ou The undersiyned owner hereby a9rees to hold and I <br /> nl0 SCALE savc harmless thc City of Everett from any and ali i <br /> �-—�- - --� — ——— ---"I claims tor damages tha[may arise because of installa� <br /> I" LIP [ion and maintenance of the improvement hereto � <br /> applied for and further agrees to remove same upon � <br /> I30" I _+30"� notice from the City and to replace ublic property � <br /> r—_w_ . . . ._. I <br /> darrtaq d�eraby. r- _ _ � <br /> `�aignatu of Applicant <br /> ;.s .� > —i i r - !��?c. <br /> �lddress � ,7 p <br /> C(�P',' Ui' li�l. I.��,'. �. . � ._ � �i <br /> f3l POS I"ED Uid J(!GS11 I _ 7 � -l; �! � _ <br /> Telephope[V mber <br /> . CALL ENGINEERING DEPT. 259�8811 ��, -> ��LZ_� <br /> I :t4 HOURS f3Ef-OR[ CONSTFlUCTIONi Date � _ .�-. <br /> CHECK LIST / � � n��� � <br /> Fee <br /> Water Valve Dept. Approval5 ' <br /> Drainage .y � • � � <br /> Qu6&Gutter Engineers _ .� .%�:!_- <br /> Sidewalk Water �, • ��.-.- );';,: � , �t._ :�w z.s..- <br /> � " � .^=-�--� <br /> ' ' � S.reet � ,+✓ <' _•.r n� �c.,.•� <br /> Communications � <br /> Inspecior's Signature � Traffic <br /> Planning <br /> i� � �u <br /> — C.-'�:t�/ _-�^'-t'� .� .YnJY�rv� <br /> �ale - — _._ — — y r ,� . <br /> L <br /> Remarks <br /> Noce: Original to Customer <br /> 1CopytoFile 1 �n � g <br /> t Copy to Inspecmr Approved by <br /> Date Approved <br />