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APPLICATION FOR RIGHT•OF-WAY USE PERMIT <br /> everett . . w O�p O <br /> � 1 o a <br /> CITY ENGINEERS <br /> EVERETT.WASHINGTON PERMITNO. �� ��GI <br /> �� The Undenigned ��i D S/� li✓,. ��i.: _ / <br /> Hereby applies for permission to ,_(��;�� s Yr.�. r .�� !- � N.i.. :��✓P!.�.,�.= � � � � � <br /> _ G�.u:._ /iv T�r= �ll_Lr_' � ?- <br /> � On/ ri-✓ P,�.��� ra,�P�:.�♦ zti ' L On,�� �� <br /> � i <br /> A[the following Ixation 2 � �� ! ��:'.?.�.'�� i��-_ � <br /> SKETCH <br /> � <br /> (Work to be done) <br /> �I <br /> ' <br /> _ i <br /> G�:,3,vr� /a v '= _— I <br /> �I <br /> . <br /> ,{�VG I <br /> .T�l�'' / �f/ II <br /> l <br /> /�} � <br /> I I:� 1 .�J <br /> �'� 7 �1�. Jj1�;��� I <br /> I I`� ��� � . I <br /> , <br /> ;� ' <br /> �,��1 �'�� 1 � 4 <br /> �j � �i� � lo� � <br /> i <br /> I <br /> �. • �. ♦�.�M�<� ' II <br /> � I <br /> �- �� I-�t y � <br /> I <br /> � ORIVEwAv SEC7ION Th�undersigned owner hereby agrees to hold and �� <br /> �I NO SCaLE save harmless the City of Everett from any and all � <br /> If'— � claims tor damages that may arise because of installa� j <br /> I� I" LIP 1 tion and maintenance of the improvement hereto ', <br /> , applied for and further agrees to remove same upon <br /> I 30" ________.�3��� notice from the City and to replace public property �, <br /> dama d thereby. � �� � �� <br /> �T!.�_a :�C.� �" � ' <br /> Signature ot Ap licant <br /> � COPY OF TH�S APPLICATION TO � � A d ss � ��J <br /> '� BE POSTED ON JOBSITE. T�hon� �� <br /> CALL CNGINEERING DEPT. 259-8811 i �5 Si.�� � � � . <br /> '� 2A I�OURS RLFOHE CONSTRUCTIO�J! Date , �� <br /> __ _�� �.o, i�y� — <br /> CHECK LIST Fee /✓C F,�c� , <br /> Water Valve D@pt. AppfOvelS ' <br /> �� Drainage G� � <br /> C�r6&Gutter Engineers �. . ���.u� . <br /> ' Sidewalk '� . � ._-�7����� ;,i �^� �, �, <br /> Water r�1e^Y 7e_,... ,�«��_� <br /> Street � <br /> �' Ccmmunications � <br /> , lnspec[or's Signature Traffic � <br /> Planning <br /> ate S' ._ , ��,. i�i-�..,e,.� � a E..%I, �; ' <br /> i <br /> Remarks ' <br /> Note: Original to Customcr �'I <br /> i Copy to File '1�7 8 0 , I <br /> 1 Copy to inspector Approved by� - ;% - . <br /> G� �,.�r,�,_ '.�� <br /> ' Date Approved <br />