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e <br />n <br />eve ren <br />l� <br />�ITY FNGINEERS <br />EV[RETT,WASHINGTON <br />APPLICATION FOR RIGHT-OF•WAY USE PERMIT <br />�.'.J�10 <br />PERMIT NO. 'i'"i' � �?i <br />The Undersigned __� �: �� � i-.i��� �- . <br />rierehy appiies ior permission to ��-Ui�i c-G'v r.T�} 2 t� ri 5i/r,�I �� /i�.. i <br />Atthefollowinglocatior� /i'.'� � I:/ '-'�r'<':o.0 !'Al.l( <br />(Work to be done) <br />--�' ijii:-Ick�D <br />�i;% �: ��; � . ,! _.� <br />'�r Eo �,� ava�L>h/c t� H�.,t�-� <br />, _ :� _:/l r;...,� cox t� �x �Jj��;.t-.1 t„ <br />�� U��,t, � _ . <br />�,.qC/e GPiH're �.,V�,i f. . <br />.. i✓..:ti %f Y`✓d�.: t"f. V✓Jfdr �_'6�, f.'r�,x L`u ��✓infr'. <br />J <br />p��ie. N� t;'��✓�.f n�_,lcJ ��. �.d,.i.ijc, <br />,6.��,- e''w�' sy:!�" <br />:� �. 5,�7 <br />I y [ F tl�,s j'�.��>�y ty f� c,::,t'�-�� <br />%%�l'r: /$ r�ov/ n J5 /)d�L l� J In iY-�I'1 fl /. <br />y . <br />/'�'%cS. l� � �jdCriOl7 XI� t��5 /Sc%mq>t�d Jr <br />i/,e SwF)c'e Idat�/ FWr*� v✓ l •t „✓,���iC <br />=� �{ �H' �/v��✓eved" � <br />./oS��o4d:� hi th�- ConSl.�ct� �� c r� ,. <br />'� {�2iAu iL� � cJ. G.�Jn�� <br />r:-�Iae:rJ by ihe � � `_'..� �G.P.�� <br />J ah G.' <br />� <br />�i ORIVEWAY SECTION <br />' NO SCuLE <br />� � <br />� 1�� LIP � <br />i �3p" I I 30" <br />—�(� —K' � <br />jICOPY OF THIS APPLICATIOPI TU I <br />'� I BE POSTED ON JOBSITE. <br />ICALL ENGINEERING DEPT. 259�8571 I <br />j 24 I!r)i;fi3 REf-01-',F.COfJSTR�ICT10fJ <br />CHECK LIST � <br />Wator Valve <br />Druina�e <br />Curb & Gutter <br />Sidewalk <br />IInspecmr's Signat�re <br />Remarks <br />Note: Original to Cust: mer <br />1 CopY to File '1 n 7 � Q <br />1 Copy to Inspectar � <br />The undersigned owner hereby agrees te I.old and <br />save l:3rmless the Ciry of Everett iroc� any and oll <br />claims for damages that may arise because of installa� <br />tion and maintenance of the improvement hereto <br />applied for and further agrees tc remove same upon <br />notice from the City and to replace publir, property <br />damag d ere . ,�� � <br />�/A--� �c���— <br />Signatdre of Applicant - .�i �.` <br />� _�ar7 .� �CJ/T i ysn.al� -� � .•�... <br />Address <br />��9- ��� <br />Telephone Number <br />Date . <br />�.' �"'. ,,4 . <br />Dept. Appro;�als <br />s <br />Engineerz �_ _. <br />�:_ )�,�<T Water_C21!�J27L.�,,�f�.�-iC-`��f_ %.. � _ . <br />- � � Stree[ �-�- - <br />� > <br />Planning � _ <br />; � , ;:.�y C-t� .� i � ..+'., _ ,�-� i�.— <br />��7'- �':�'.�i� fi..., :�: �._ ) <br />i <br />Apptayed by— <br />4 1� <br />__j �' �. <br />Uate Approved <br />F <br />a <br />