Laserfiche WebLink
everett <br /> APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> 10257 � a <br /> _ � <br /> CITY ENGINEERS 7 � �' <br /> EVERETT,WASHINGTON PERMITNp, /---� — /�--T <br /> The Undersigned �U�'.�� 1_3. K9 t3 E.P N O LT Z� � <br /> . Hereby applies forpermission to�'ayfT.P�/�T /S��Oit/ ,P Tf /�/Uj/L y , <br /> I� At the foilowing location_ /�O �ri /l�. ��qN D � <br /> LoT � �;-� <br /> SKETCH <br /> I (Work to be done) . r �� <br /> I y I <br /> i <br /> � � , � � <br /> , — 40 . � �� <br /> � ; <br /> � <br /> � ; � ����-� ���,���� V <br /> I • i 11��i��( -J-S� j <br /> � �1 <br /> J4 U 6 ! /i� I <br /> I , � � N u rt : <br /> , � � -�, r �zar-r-ic � i ��� r� � I <br /> �� � Q� uovtr� <br /> \ '� <br /> � N�i!! f._'+JAIi:' �<t �; L);.,;i � <br /> i <br /> � <br /> I <br /> � <br /> i ��.7� I <br /> � <br /> � u�s�-a� � I, <br /> ! F�r.s�r�rv��- f � � <br /> i cuRa. JvTit �� y��w` � , <br /> i <br /> I <br /> � DRrvEwAY SECTION � �� j� 6 � I� The undersigned owner hereby agrees to hold and <br /> �',I , N��;E . save harmless the City of Everett from any and all � <br /> �--- -� claims for damages that may arise because of instaila� � <br /> � i" LIP r'- tion and maintenance of the improvement herem � <br /> I I I applied for and further agrecs to remove same upon <br /> � 3�T— f�--�}''���y notice from the Ciry and to rep�ace public property i <br /> 'I dama d thereby. <br /> � �� <br /> J Si nature of Applicant <br /> �i COPY OF THIS APPLICATION TO � � �������� L" ��� �"����� 1�' Address � � � <br /> I BE POSTED ON JOBSITE. � - T �5 �S 1 - D 77S '. <br /> C��L FNGM[ERING DEVT. 259�8E11 Telephone Numbe�� ',, <br /> � �7d NOURS BtFORE CONSTRUCTION� Date i - ' <br /> i - - - � ��7)— � Sn ��� � <br /> , CHECK LIST Fee <br /> Water Valve i i <br /> � Drainage e . Approvals p <br /> ' Curb&Gutter i 4 Engineer � �'h'�u'�� �-('-J,� �� <br /> Sidewalk 'Y �% • � <br /> . � � Water ! , <br /> � i, _ ��i _ � <br /> � � Street � C . . . <br /> ��' i �� / ,t_�'�� � Communica i ns '~.l%�� � ��- �-/%7�- �I <br /> � Inspec[or'sSignature Tralfic - / � - �j 3 � <br /> ;- _ .;� �- ?J Planning -- / � � <br /> a[e ! <br /> �, Remarks ' <br /> Note: Original to Customer <br /> � conv �o F�i� 10 2 5 7 <br /> 1 Copy [o Inspectm� Appr v d �/ <br /> �fi.i [S �%S�-�7.�� <br /> � , <br /> Date Approved <br />