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APPLICATION FOR RIGHT•OF-�NAY USE PERMIT <br /> everetl <br /> � 1� Ob0 <br /> CITY E;iGINEEP.S ^- �/_ _� <br /> EVERETT, WASHINGTON PERMITNO. / � �Cv <br /> T—— <br /> The Undersigned �� i-; N�- r � ��/ . — <br /> � Hereby applies for permission to i"-?/�STi� u !� i� y /S �IISiJI>ia 1_ i �/v✓ 'S _ <br /> At the following location �� c7 Z � r � i? %' � -; :Z2�Z �'�<, — <br /> SKETCH <br /> (Work to be done) <br /> =,� A ����•��� _,� <br /> 'I . <br /> I <br /> , <br /> i <br /> ,, ` I <br /> ; 1 .. <br /> , . <br /> I� The undersi ned ownen c�reb a rees[o hold and <br /> DRIVEWAY SECTION 9 Y 9 <br /> NO SCaLE save harmless the City of Evcrett from any and all � <br /> �^— � claims for damages tha[may orise because of installa- <br /> i +�„ ��P —� tion and maintenance of the improvement heieto <br /> —+ apolied (or and (urther agrees to retnove same upon <br /> �' 30'� —� ____- __�3p" <br /> — notice Trom the City �nd to replace public property <br /> car�ag�lhe�r ��y/ � <br /> �����l�4��.�-'�F� T-�.rf . <br /> Signat5re f Ap.�licant <br /> ' � F.���c7 �vY <^:P�� �f/i <br /> I� COP`! OF TI;IS.^.����iJCAI-ION l0 Addre<_s <br /> ��.�.� POSTED 'JNJU851TE � 3�^S� 6 'f , � <br /> � !;F,LL E^'31N6FRING D[PT. 253�8817 i Telephone Nvm�� ' _ � �, <br /> "'�I iiOUR; GchORE CONSTRUC i ION� Date � � <br /> CHECK LIST Fee� '.iS-'"� � <br /> Water Valve D�rovals � <br /> Drainage � � I <br /> Curb&Gutter f.ngineers . I <br /> � Sidewalk Water <br /> Street <br /> Communications , <br /> inspec[or's Signatur� Traffic <br /> Planning_. �i <br /> —DSte -- II <br /> Remarks �� 'I <br /> �� Note: Original to Customer I , <br /> , �o�Y t� F��� 1_10 6 0 ---- <br /> 1 Copy to Inspcctor Approved by <br /> Date �1UProv����_ . . <br />