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c� •rett <br />� <br />CIT�� ENGINEERS <br />EVERETT, WASHINGTON <br />ll Unde si ned ��-� ��� <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />�Oi82 <br />ie r g <br />Hereby applies for permission to - � � ' %� ��� - �� � � � <br />At the following location_f- S i � /- /-�"i<� i �i/ ���_. — <br />SKETCH <br />(Work to 6e done) <br />� � ,� !'�'ii/'���'%•�% <br />OR!VEWAY SECTION <br />NO SCALE <br />� +I" LIP / I <br />i-3O-;-_ _�--_ --.i.3~a <br />I COPY OF THIS APPLICATION TCi I <br />BE POSTED ON JOBSITE. , <br />CALL ENGINEERING DEPT. 259�681 I I <br />, 24 HOURS BEFORE CO�ISTRUCTIOi-I� <br />CHECK LIST <br />Water Valve <br />Drainage <br />Cur6 & Gutter <br />Sidewalk _ <br />PERMIT NO. % 7- I � <br />The undersigned ownor hereby agrees to hold and <br />save harmless the ;ity of Everett from any and all <br />claims for damages that mry arise becau::e of installa� <br />tion and maintenanc2 or tha improvement hereto <br />applied tor nnd further agrees to remeve ;ame upon <br />notice froro the City and to replace p�blic properry <br />dama e � <br />9 Hl`/. 1 <br />t /�i/e�c� /7Gs'.t�'_�nt� <br />Signature of .dpplica t ` <br />_�1LoZQs7 - � • L � � C d.,.. � . <br />Address !, � `�� <br />�j�:cS�> - ���n / _ <br />Telephone Number <br />-- `'��- v�f-7� <br />qI Ly��� Da(c ��%/ <br />''� � � '." �l ,�i <br />.L Fe� <br />� <br />�� ��� <br />� J �� <br />Inspector's Signature <br />Renarks <br />tJctc: Original to Customcr <br />i Copy to File � n�� 2 <br />1 Copy m Insper.tor <br />�IS Dept. Approvals <br />Enginee/rs� � �� �1.�� `" � <br />Wa[cr__Y/�i•rt��, ��.�f9r�,E..-.1,�,� <br />/ <br />Street ,�� � �,,,,�� -�' � f�� Z--- <br />Ccmmunications <br />Planning <br />n / <br />S��.i. r�� / �d�.Ai / �-� <br />�l <br />Approved by <br />Datc Approved <br />