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• everett APPLICATION FOR RIGHT-OF•WAY USC PERMIT <br /> e 10951 <br /> CITY ENGINEERS , , <br /> EVERETT, WASHINGTON PERMIT N0. ;�> >��'`�' <br /> . The Undersigned : • � � � ` .� �� � - .-•r,� _ � I <br /> , Hereby appiies for permission to .� �.� � i.r ; c i ,-j // � - 1)/c�i - 7 ,� �T; i,./ �� <br /> � ,. _: � !l/ .� ;' r.as �.. <br /> --r <br /> � At the foliowing location 'ti.��l /:/.- , -,� , v i <br /> SKETCH ` j <br /> , (Work to be done) � <br /> � .: . � f�`J rfi./':.��:1 . � <br /> � i <br /> i <br /> a � DRIVEWAY SECTION The undersigned owner hereby agrees to hold and <br /> � NO SCALE save harmless the City of Everett from any and all <br /> �� � � claims for damages that may arise because of installa• <br /> ', i" Lip tion and m�tenance of the improvement hereto � ' <br /> � applied fo and further agrees to remove same upon � <br /> �30'�_______ _ 30' y public properry ' <br /> . � -�� notice from the Cit d to rep lae�e <br /> '� damageii t ereby. / �1� � <br /> ; � (� �-� <br /> � . <br /> � " � Signature of App ca � / � I <br /> F , _ ' �b I A 4 '1� !V CV�� ,`i <br /> COPY OF THIS APPLICATION TO �res� ._� � � �� <br /> BE POSTED ON JO4SI'i E, �? � j - � I�, <br /> ' C�aLL ENGIN6ERING DEPT. 259-881 � Telephµpn,e Numb!�yr ^7-7 <br /> -�l�T / 7"7 ��l / I <br /> I24 I-IOURS BEf-ORE CONSTRUCTIOD! Date i _ � � <br /> CHECK LIST PeC ` %� �� r ' '~/� � <br /> Waier vaive �Dept. Approvals <br /> Drainage <br /> Curl�&Gutter Engineers %�' � <br /> �� Sidewalk � ' � <br /> Watcr <br /> Street <br /> Communications . <br /> Inspectar's Signatum Traffic <br /> Plannin� <br /> �ate <br /> � Remarks _ � <br /> � Note: Original m Customer <br /> 1Cop� toFi�e ��(3CJ� <br /> 1 .:upy to Inspector Approved by <br /> Datc Approved � <br />