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i _ APPLICATION FOR RIGHT-OF•WAY USE PERMIT _ <br /> � J�vr.rett. " � �O O�� �I <br /> ; e <br /> ' CITY ENGINEERS ' <br /> , EVERETT,WASHINGiON PERMIT NO.-,�� <br /> I The Undersigned G H�T � O t— � C <br /> i <br /> Herebyappliesforpe�nissionm ��DAIS"CYZ .Q Z�S � �..1) � [�r' Ll1b,C. � n12.� U� ��4 <br /> �� At the followiny Ixation 9 3 / p/�A�e�i 1//�G1.� /�" LI�/� , <br /> i SKETCH � �, <br /> '� (Work to be done) � � <br /> i <br /> I �i <br /> , s <br /> � r� <br /> � <br /> �� � , <br /> i � R �o � <br /> I ¢ � <br /> �o � <br /> i 5�� ' <br /> � \� <br /> � <br /> � <br /> � Pn.c�� g <br /> � � <br /> � � <br /> , pRAINAGE � <br /> C-ASEM�N� � <br /> \ <br /> � <br /> DRIVEWAY SECTION The undersigned owner hereby agrees to hold and , <br /> � NO SCAL� save harmless thc City of Everett from any and all <br /> � �— 2 S ---� r����� claims for dama�es that may arise because of installa� ' � <br /> Y' LIP tion and maintenance of the improvement hereto � <br /> II appiied tor and further agrees to remove same upon <br /> 30" .___ _�.3�" notice from the Ciry and to rep�ace public property <br /> ' . �ar�age re � <br /> . <br /> I . _.. .._ ..—_ $igna[ureo App ' t •_ � �� <br /> —� .S! <br /> COPY OF THIS APPLICAiIOfJ TO Address <br /> I E1E POSTED ON J06SITE i �� 3 — � 3�S I <br /> CALL ENGINEERING DEPT. 259�8817 Telephone Number � <br /> i 24 HOUIi; RPf=pRE CONSTHUCTION Datc � � �=v /j�/ � `� �/ <br /> .— <br /> � CHECK LIST � Fee' I - <br /> Water Valve 7 ('�r.C. � ' � ; <br /> � �`E��P � � Dept. Approvals <br /> i Dreinage y_ �,7 . <br /> Curb&Gutter - Engincers /y� � ' ��'� <br /> Sidewalk � <br /> Watcr l", ��;�a _ <br /> / Street f�.' f :�L � <br /> � l�rn.. �'L��r���_ C•;'79fd�C�'![� � .' —? 7 — �� Communicatior C — <br /> Inspector'sSignawrc ' .f`� , , � � <br /> K�x ���.-� Traffic_ !� <br /> �, Plannu � � � '�. <br /> ��,_�_., y <br /> atD e <br /> Remarks <br /> . Note: Original ro Customer <br /> i Copy [o File 1 O��9 , • <br /> � 1 Copy to Inspector ApproveJ by v � <br /> � ��r"�--�' <br /> Datc Approved � <br /> 9/�/�� <br />