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ev�rett <br />� <br />CITY EMCSINEERS <br />EVERETI'. WASHINGTON <br />APPLICATION FOR RIGHT•OF-VJAY IISE PEAIVIIT <br />1_Qt�� $ �.` /. , <br />�� �� �� <br />PERMITNO. ���' --. `.' <br />The llndersigned �_�,��--� � ��=F� r r <br />He��auy apPlies for permission to '���' c f,- n t t �/�� �/� ./� ���� <br />� - <br />At the following location__ � i?/'� 7 �,c/ �� � <br />-- r, F .� � „—�u._—i7, ' ,� � <br />IWork to t�e done) <br />�RNEWAY SECTION <br />NO SC4LC <br />� �ZY: � <br />� +I'� LIP _� <br />��y+' .�-- I 30 J <br />—�t' -i <br />C0�'Y OF THIS APFLICATIO�' TO � <br />[3E POSTEU OM JOGSITE. <br />', C�.I-I_ �P;OIN[FP.ING DEPT. 25&F3Fil i�� <br />; ���uur:, ���� r-oRe cords-Fu�:r�u:� <br />' �CHECK LIST � <br />Water Valve <br />Drainage <br />Curb & Gouer <br />Sidewaik <br />--�-L�Y'}'C.�..c _ <br />I nsp"eCtor'S 6ignatu re <br />. �. t �' � � <br />I ' <br />�te --" <br />Remarks <br />Note: Ori9inal ro Customer <br />1 Copy [o File "� � � � � <br />t copy to cnspector ��� <br />�`�u Jf4�G <br />%- ' /'e: v�.: �.,..... � <br />J- ��_7G <br />e " <br />F = � <br />_ .._. l <br />�f,,�,� <br />.iU'- <br />T e L4 y <br />�7 i � d f <br />N � <br />��� V i <br />1 ' rO <br />� iw h <br />� 7� <br />T � <br />�, � <br />� � � <br />The undersigned owner hereby agrees [o hold and <br />save harmless �he City of Everett from any and all <br />claims for damages th. t may a�ise because of installa� <br />tion and maimenance of the imprcvement herero <br />applied for and forther agre?s to remove same upon <br />notico-fyrom the Ciry and to replac pyib��c property <br />darpSgetf tliereby. - ��' �: <br />`r;- <br />� ,_ �, � ���/�, <br />Siynature of Appl6;ant �' ��'..� - � — <br />> <br />% /' /"7. � � �7/ s,-�' - �� 1 <br />�' _; <br />Address <br />i ' % n'�� 5 7 <br />Telephone Numbe� <br />i� ,2 i - -'/_ <br />Da:e i <br />� <br />—/ f �" --"-'A^--- ? " �' � <br />Fee <br />Dep.. Ap rovals <br />i i <br />En9ineer -- `�� - <br />Water�_/�✓„ /ia� /��„�.tir_�o .3�i/J <br />Street f'' <br />-�-'--� -, �' � '�-- <br />Communications L-�� <br />,� � � � _. <br />Traffic_ 'r; ��__ <br />Planning�- � ��, <br />SEE�e� �� <br />/ / <br />Approved by ,/7� / ��_/� <br />� � P/� / � �_ <br />Date Appr ved <br />