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APPLICATION FOR RIGHT-OF•WAY USE PERMIT <br /> eV� 11049 <br /> �' CITY ENGINEERS 7�.35 3 <br /> EVERETT,WASHINGTON PERMIT N0. <br /> '�, The Undersigned� �"�;�!\ .=:; ( ['�.?n.•'� .t/ �LJ-n ;rv�: S� . <br /> � / <br /> 'i Hereby applies for permission to ,��i�V �T�c'u(' 7'� �- 2 j �' ���t/C�_t',�_=9 (�/�c./ �, <br /> F.t the following location 2 y � Pi.�/',�5� /7� �I <br /> �, SKETCH '� <br /> '� - , (Work to be done) �, <br /> �,, SE%" �-��,a c�f=� �� <br /> i ,, ; <br /> i � <br /> �� � I <br /> � � <br /> � i <br /> � � <br /> I <br /> ; <br /> � � <br /> � <br /> � <br /> i <br /> i <br /> ; <br /> I � � <br /> i <br /> I ' <br /> � � <br /> � <br /> I <br /> � ; <br /> � o <br /> ; � <br /> , � <br /> DRivEwAv SEc7i0N The undersigned owner hereby agrees to hold and <br /> NO ScaLE save harmless the City of Everett trom any and all i <br /> r---- — � claims for damages that may arise because of installa- � <br /> I I" LIP tion and maintenance ot the improvement hereto �, <br /> � applied for and further agrees ro remove same upon �. . <br /> I30�� 30 notice from the Ciry and to rep�ace public property , <br /> � dam �re . /� � <br /> I �� <br /> I a[ure—of �plican[ <br /> i --- -- - ./�D �. ,�7< 7 <br /> COPY OF THIS APPLICATION TO i Address . <br /> I BE POSTED ON JOBSITE. 353-/e SOA . <br /> �'I CALL ENGINEERING DEPT. 259�8811 �� Telephone Number <br /> I <br /> �,�� <br /> ; 24 HOURS PEFORE CONSTfiUS"fIOP!' ate ` . <br /> �� CHECK LIST Fee %"�� �' � <br /> Water Vaive Dept. Appfoval5 � <br /> � Drainage o � <br /> ' En ineers <br /> � Cur6& Gutcer 9� �, E.0 te.� � � <br /> � Sidewalk Watcr � ' <br /> ' Svice[ <br /> Communications <br /> Inspector's Signature <br /> Traftic <br /> Planning <br /> ate <br /> Remarks <br /> , Notc: Original to Customer <br /> , �onY to F��� 110 4 9 <br /> � 1 Cupy to Inspector Approved by <br /> Date Approved <br />