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APPLICATION FOR RIGl1T'-OF•WAY USE PERMII' <br />everett <br />� <br />CITV ENGINEERS <br />FVERETT,6NASHINGTON <br />The Undersigned �%i-i� �: � r'. <br />Here6y applies for permission to <br />At the following <br />(Work to be done) <br />DRNEWAY SECTION <br />NO SC4LE <br />r � <br />I" LIP __� <br />30�� � �� �,.3�Y. <br />� <br />.�_�P`i OP THIS APPLIf.F\iIUN 1�U <br />�,il POSTED ON JOBSiTE. <br />..'LI. i L'Gt�:i-ERING DGPT.259-SCi I <br />�. � :�IOI;i;: (1[FORCCONSTRUCTl01d <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Guttcr <br />Sidewalk _ <br />Inspeclor's Signaunc <br />Note: Oriyinal [o Customer <br />i corv t<, r�i�, ;I (J i' :13 <br />1 Copy to Inspc[tnr <br />1 •; <br />--> <br />10723 <br />PERA9IT <br />The undersigned owner here6y agrees to hcld and <br />save harmless the City o! Everett from any and all <br />claims for damages that may arise because of installa� <br />tion and maintenance o( the improvement hrsreto <br />applied for and further a9rees to re,nove same upon <br />notice trom the Ciry nd to replace public properry <br />dumagea i`+ereby: � �' �! ' � � <br />Signature of Applicant <br />� ���� hrvr��r G n��c•� �.�. <br />Acldress <br />y' S''�] — 770d <br />Telephonr. Number <br />=,� �a� 77 <br />Date / , S9 � <br />L � <br />Fce <br />Dept. Approvals <br />� . ��� <br />Fngineers_ r_ .,,�i�i l%y.� r <br />Water._7/t ,.�; 'r_�_y �-%`a, /'�K;��� <br />q � <br />Street ��_._. � _ -�_� <br />Planning_ <br />f � <br />s., ��'-; ,, �„-0,� -�� <br />��Pnroved by <br />Datc AUp�ored <br />� <br />