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y ; � <br />�� d <br />�ENGINEERS <br />JERETT,WASHINGTON <br />TheUncersigned �/C/ <br />Hereby applies for permission to <br />At the following <br />(Work to be done) <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT 113 Y 1 <br />2� <br />=� <br />ORrvEWAY SECTION <br />NO SCALE <br />� � }� LIP / � <br />r30'�-� _I_30"_I <br />� C.OPY CP �;!IS A^PUCP.TION TO i <br />�SE POSTF.D 0\ JpBSITE. <br />. CALL EidGINcERING DEPT.25&8817 <br />tI?.�l NOURS SEFORE CONSTRUCTION i <br />-- ---- <br />CHECK LIST <br />NJata� Valve <br />Drainane <br />Curb & Gutter <br />Sidewalk <br />Inspector's Si9nature <br />Remarks .I � `S �� .�• <br />1. <br />PERMITNO. 78— 2yZ <br />S rl•u C_ <br />The undersigned owner hereby agrees to hold nnd <br />save harmiess the City of Everett fron and ail <br />claims for damages that may cause of installa- <br />ti�and maintenance e improvement hereto <br />e�ag;ees to remove same upon <br />ar.J to replace pu6lic property <br />r_ . �r�L��- <br />_���c ��:� �`_ s L.�a-r.�i� c�+ i�i�r�U <br />Addiess <br />�r/�/N w�)c��) ��-l� <br />Teiephone Number ,�„ r � �� �.–� <br />Date <br />�- s <br />pept. Approvals <br />Communications <br />Approved by <br />GUfTONiR Date Appro�ed <br />