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s <br /> APPLICATfON FOR RIGHT-OF•WAY USE PERMIT <br /> ��� 11Q2 (� <br /> CITY ENGINEERS "" ' <br /> � �/�' S <br /> EVERETT,WASHINGTON PERMITNO. '• <br /> The Undersiyned��K r tTei_�o iv _ <br /> . <br /> He�eby applies for permission to�l=��."r�il I:Z/� �J /,�/ �if0,^�.%. i1/ � ,i� •S/�7�%�N�L K <br /> At the tollowing location i J � ��j!�'!�/l� _ <br /> SKETCH '' <br /> (Work to be done) ' <br /> 5��� /'-}TT/� c_N;U � <br /> ORrvEwAY SECTIJN The undersigned owner hereby agrees to hold and <br /> NO ScaLE save harmless the City ot Everett from any and all <br /> �- — �— --�- � claims for dama9es that may arise because of installa� <br /> ��� ��P tion and maintenance of the �mprovement hereto <br /> applixd tor and further agrees to remove same upon <br /> 4„30';,�__._____________�30� notice from the City apd to replace public properry <br /> dam jdthere�y. � _r ��. <br /> G� _ <br /> � - <br /> `Signa:ure ot kpplicant � <br /> � �960 �/.� <br /> � COi'�' OFfHIS ,1�i'IJC:"�ilONl�: ddress <br /> B[ P05TEU OfJ JO[3SI i E. � .� � �- D U FJ S . <br /> Telephon Numbe � �. <br /> CALL ENGINEERIPIG D[PT. 259-8&1 I � C � . <br /> �� ?�i II(��I1Hti HEFOHE COftiSli:iICTIQf4�l Dalc� � <br /> � CHECK LIST Fee ,�yJ FisC, <br /> Water Valve Dept. prOV�ls <br /> Drairage ( i /f�i . <br /> �� Curb&Gutter Engineers , ��(.C.f/u/ <br /> Sidewalk Water_ �. <br /> Street <br /> Communications <br /> I nspector's Signa W rc I raf t ic <br /> Planning <br /> � --------- � <br /> Remarks <br /> Nole: Original to Customcr <br /> , c���v �o r�i� 'i ; (1�� — <br /> 1 Copy to Inspecwi � � Approvad by . <br /> Date Ap�:•�oved <br />