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eve�en <br />e <br />CITY ENGINEERS <br />EVERETT.WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />10530 <br />PERMIT N0. �� — / � ✓ <br />TheUndersiqned G • J� ���T�C�L.l2'' _ <br />Hereby applies for permission to �C�N �T2 �'�'.� �/�Spi�� L% L��/..J �Ill <br />_/T�' �- n - \/l% <br />At the follo�ving <br />(Work to be done) <br />47�Q <br />ORIVEWAY SECTION <br />NO SCALE <br />�-- �LS----{ <br />I" LIP <br />30'y—.—_—_ __.1•30•1 <br />-i- <br />COPY OF THIS APPLICAiION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGI NC-ER W G DEPT. 253��61 1 <br />2A HOURS �EFORE CONSTRUCTION <br />ICHECK CIST <br />Water Valve <br />�, ,+�r Drainage <br />' Curb & Gutter <br />l <br />Sidewalk <br />/1'�i'�/✓ 1 \IJ�i1Vi� <br />�/ tc �� ��-lF—Li�' - <br />m� ector'sSipnature <br />-I-7/ <br />Remarks <br />G�.v:�7� <br />%,SPr-�c.�.T l7f � <br />� <br />A <br />/ <br />/� <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and all <br />claims for damages that may arise because ot installa- <br />tion and maintenance of the improvement hereto <br />applied for and further agrees to remove same upon <br />notice from the Ciry an�i ro replace pub�ic properry <br />dartl-_�her Y. .. .�' ���� <br />i � <br />Signa of Appli nt j <br />i�0�,r r�.»�.,,w �'3�� <br />Address � <br />`l�rf��l Gfi r �'�� S� <br />Telephone Number _ , <br />3� � - �/s'y9' <br />Dare <br />iz -5-� ���� _�� r��/k�� <br />Fce <br />Dept. pprovals <br />1 r- <br />Engineers___�j^ b ` <br />Water�R,Uawj rr �esFsC�i• �-{�Y,{� <br />��'l.i / ♦ .�.����N (� �'-�`� � <br />_ `$VCCI k�I�,�'�. .,.,# <br />Communicati r , <br />. �. <br />Traffic ' � � • � '� <br />Planning <br />�L� � T;/0 ��S�•'�u. �Y C s n. � �i,/ i I <br />� / �', __ �r•o/�r <br />Notc: Original ro Customcr <br />,�aPY��F��� 10530 ^ <br />1 CoPY to Inspecror � 9P ovhd by_ ( �1 J C y� /.k/ <br />`_—�.w.. OI.,S � h -,'��r-_. � . ��/' <br />Date Approved <br />