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everetl <br />� <br />CITY ENGINEERS <br />EVERETT. WASHINGTOfv <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />�0846 <br />PERMIT N0._ � �' /.t 7 <br />Thc Undersigned �� �� 7 ��l �.� �: �r���y4 L_{) <br />Hereby applies for permission to �r/: 7•. v� — /-1 :. i� A:Ci� -a n l <br />At the foliowing loca[ion 7 ti/ F =l ��»L ani n 71' <br />(Wark to Ue done) <br />�RIVcWAY SECTION <br />NO SCALE <br />r J, <br />I LI� � <br />�3�•�__ __'—_--�„30"^j <br />COPY OF THIS APPLICATION TO i <br />BE POSTED ON JOBSITE. <br />i <br />CALL ENGINEERING DEPT. 259�8811 ,I <br />�%� IIOUI�S 13Ff�ORf: CUPd:>TRUt`I�ION I <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />Remarks <br />Note: Original to Customcr <br />7 Copy to File ��� a. g <br />1 Copy to Inspector <br />Scr' i�'7F1C//c'_� <br />� The undersig� ed owner hereby agrees to hold and <br />� save harmless the City ot Everett from any and all <br />claims Tor damages that may arise because ef insta�la� <br />tion and maintenance of the improvement hereto <br />applied for and further agrees to remove same upon <br />notice irom the Ciry and to replace pub�ic properry <br />da ced thereby. //{�� n <br />, / Y fi � / 12 � ...�f' f <br />Signature nf.�pplic nt <br />�/2-1`-'ai��/�.. ��}� .l�"a�, 9s�p3 <br />Addrcss <br />353- 39s,� <br />Telephone Number <br />lo' /3' % % <br />Date � <br />! '�" �'S= <br />Fec <br />v� <br />`Dept. ppro%vals <br />Engineers_ C� r �AE{ J <br />i <br />Communications <br />Plann <br />Approved by <br />Date Approved <br />�. <br />