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�, �p APPLICATION FOR RIGHT-OF-WAY USE PEP.MIT <br /> everetl Y� <br /> e ` 10223 <br /> CITY ENGINEERS <br /> EVERETT,WASHINGTON PERMITNO._ /—� — /O j <br /> I TheUndersigned �'J,�,t,c�.1i c f- J/ C�)A/ CT�` C�� ' <br /> � Hereby applies for permission to �n�/ �-rTi uc 7' ,Q �S ��` ���J �, <br /> i At the following location � Z 7 � <br /> 4--Q�.s s t �. �T,�� �- >> <br /> SKETCH <br /> ,; (Work to be done) � i <br /> i , . � <br /> I � <br /> , �Oi <br /> -- ���i <br /> � � � i <br /> ' M N <br /> � �p,1 � v � ����, bl� <br /> 1.�1 �_ N� ��1 <br /> 0 <br /> J � _w <br /> �fj � <br /> W <br /> � � � <br /> � ' <br /> I Q <br /> � �X i �� �1NG' GvRB � ! <br /> i C=UT7"�j� <br /> 8' -S/w <br /> � l4� 6AcK -S�w <br /> i <br /> I <br /> DRIVEWAY SEC710N The undersigned owner hereby agrees to hold and <br /> I I <br /> NO SCaLE save harmless the City of Everett from any and atl <br /> � �3 -----� �� <br /> � claims tor damages that may arise because of installa• � <br /> I ���� ��P --�� �`�:)A , tion and maintenance of the improvement hereto - <br /> � 30" _ _f� _�gp•• applied for and further agrees to remove same upon � <br /> I ' notice irom the Ciry and to replace public property I <br /> i dama9e �eby. �� 7��� � . <br /> i <br /> � aignature of Applicant� �� '-- �' <br /> � - I <br /> �� COPY OF i'HIS APPLICATION 70 I �wK .�Y Ad ress ' <br /> BE POSTFp ON J0651T[. �o J �• � ��NW < < /� ,/� �b'6J,G '� <br /> � H '�iV <br /> CALL ENGINEERING DEPT. 259-£Z871I ���epnyne rvumber <br /> . 24 HOURS E3EFORE CGNSTRUCTIODlI G/ZO/7� Date ,�� ~/� S � � <br /> CHECK LIST Fee 7 sa ��� � �/���/�r : <br /> Water Valve / / j' � 3Ssi <br /> Drainage � �+{r �'�'vi/<� �O b e r�rcvc��orr Dept. Appro als � <br /> Curb&Gutter "cr/1y y t d 6r�Io�C �+r/�y, 6y EwD iT Engineer � L � <br /> Sidewalk � <br /> ( us �. ea nse, / .�1 � <br /> �� � � (" ��/ �Water . � <br /> ��.��� ���/�- ���, Street�`�'!�^���,''�`��'�� �. <br /> � / � � � Communicati �-•=*• �•— <br /> � Inspector s Slgnature ��--A-� _�-�"�y- 7�— ' <br /> �' - _ Traffic � �. <br /> ate '�,..,... , _ �' I- .. Plannin ✓ � � �/ �D � � : <br /> J <br /> Remarks — <br /> Nute: Original to Customer <br /> , �°PY `° F''� 10223 <br /> i Copy to Inspector Approved <br /> Date A ' � :j ��/ . <br /> pproved '� <br />