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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> � � � evcretl 1 0 6 3 3 <br /> � � <br /> � CITY ENGINEERS . . <br /> �, EVERETT,WASHINGTON . PERMIT N0. � � , <br /> �, The Undersigned � �� <br /> � Hereby applies for permission to � � r i i �� � � - �' ' ' <br /> � <br /> At the following location � �� ' �' <br /> SKETCH <br /> � (Work to be done) ___ . . _ . _ _ . . <br /> i - --- �,. -- .✓ � �.� — <br /> ----- ... .- — - __----- —L- _��„z�_�,__._ <br /> • �, +_. 1. i .li ,,. . ..1� .�:t <br /> � �� � � <br /> I W f I <br /> ! __ . __I 1 !� '. <br /> � � � � <br /> � � f�l- l�l rK ➢� �_�� <br /> � `1 , I <br /> � I )� I �.� �-�. R�a� � ` � <br /> � '- .K �)�J I . <br /> i __— <br /> i ._ _"____ , ' <br /> I � <br /> � � <br /> j � <br /> I <br /> I <br /> �� � <br /> I <br /> II <br /> � DRIVE\YAY SECTION � The undersi�ned owner hereby agrees to hold and <br /> NO SCALE save harmless the City of Everet[trom any and all . <br /> L — - -�-- - �- --� claims tor damages that may arise because of installa� � <br /> I <br /> . +I" LIP �� tion and maintenance of the improvement hereto � <br /> . app�ied for and further ac�rees ro remove same upon <br /> . �3_0_';,�__ _.__.____�.30��� notice from the City and to rep�ace public property <br /> �I d/afj�iaged thereby ' <br /> � /�• y_ i 7.C7 '^ n.�-FJ_� . <br /> I Signature of ic nt � . �� i�'�'1G� <br /> � 1L . , '" i�;i,. <br /> COPY OF THIS APPUCATION TO � Addrefs ' � <br /> 'I 8E POSTED ON JOBSITE. I � � ���" 3 � � L � <br /> Telephone Num4er � <br /> I CALL ENGINEERING DEPT. 259�8811 i i� _ ') k� 7� � <br /> ' 24 HOURS BEFORE CONSTRUCTION� Date ,. � <br /> ---._. _. .--- � - i ; �. ;- <br /> , _ _ I': I ! i � .T, <br /> ' CHECK LIST Fcc � ' " . � <br /> Water Valve Dept. Approvals <br /> Drainage <br /> Curh&Gutter Engincers � , <br /> �� Sidewalk Water <br /> . . . . Stree[ � � � <br /> ��/ �l(�� Communications � "' : <br /> � Inspecmr's Signature � — Tratfic_ , '. <br /> � � //� /' � ?lamiing . . . <br /> —6ate <br /> 2�.ti- _ c..�� �7 <br /> Remarks � i <br /> Note: Original to Customer ' <br /> i CoPY to Pile �,�6�� ' <br /> '. ] Copy to Inspecror Approved by . <br /> � Date Approved <br />