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_ . r i <br /> APPLICATION fOR RIGi�T•t�F-WAY USE PERMIT <br /> eY� 107b?. <br /> � <br /> ', CITY ENGINEERS � <br /> I EVERETT, WASHINGTON PERMIT NO.� 7� �/Z <br /> � The Undersiyned_L�� i%/i)�L7�i; ��i f,ini5d iv' �, <br /> I Hereby applies for permission to "J.�/S%j7J� ? ta '�--�� �%D Al�J;l�'�i>� ��V.� � ___ ', <br /> r <br /> At the following Iocation�,S�i 2 /7��A/%�i.'./ r'(._✓i7 _ _____ � <br /> SKETCH <br /> � (Wurk lo be done) ' <br /> ; , _ +_____ � <br /> I 51.• , r � , i-r ;r��7 <br /> � I <br /> , I <br /> I <br /> i <br /> I � <br /> � <br /> � <br /> iI <br /> � <br /> � <br /> � <br /> i <br /> � ORIVEWAY SECTION The undersigned owner herehy ayrees to hold and � <br /> NO SCALE save harmless the Ciry of Evere[t from any and all <br /> r- — � claims tor damages that may arise because oi installa� � <br /> +I" LIP �� tion and maintenance of the improvement hereto <br /> � applied for and further agrees to remove same upon <br /> � � natice from the Ciry and to repl e pu6lic properry <br /> . 30�„_—____—_—_.__�30�� <br /> i dama9e�1]1�.+�� � <br /> '� Si n t��o�p.P�s.� 1� ���y[���t <br /> � - - I —�0.:10 � �• �. ��c �dp4 <br /> I � OfY Of- I,iIS APPLICdTION TO AddreQss ` <br /> fi� POSi[D ON JOBSITE � --J�d d�' �� � ' <br /> I�I '.ALLENGINEERINGDEPT. 259-IIFlil TelephoneNu ber � <br /> -�=oz/- �7 <br /> I '4 li0UR5 CEFORL= CONSTRUCTIO:�L Date _�_., � �i <br /> i <br /> i <br /> . CHECK LIST Fee ,l- �L ' <br /> \vater Va�ve Dept. Approvals <br /> . Grainage ,� <br /> ' Curb&Gutt�r ' Engincers � �� '��� � <br /> �dewalk � Water,�yn � �� <br /> Strcety/�. �' �'^ � <br /> Ccmmunications <br /> Inspector's Signr.wre Traffic <br /> Planning �+ <br /> at-6 e -- S�. =✓/�. .t r•� �y 1..,� � <br /> � <br /> Remarks <br /> Note: Original to Customer �7p <br /> 1 conv to Filc 1 � ( O'� <br /> 1 Copy to Inspector Approved by <br /> Datc Approved <br />