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_ eve�ett <br />e <br />CITY ENGINEERS <br />EVERETT.WASHINGTON <br />APPLICATION FOR RIGHT•OF•WAY USE PERMIT <br />PERMIT <br />The Undersigned f) c n_, ,- r! i�.. �/�� �,�, !-1 r• r i ��-; <br />Hereby applies tor permission to 1��� r 1 i�. I 7 � � �.; /� ., /7 �/; i �, � <br />C_ : i ,� (< - %`- S�L_. — <br />At the following location <br />(Wo.k to be done) <br />DRIVEWAY SECTION <br />NO SLALE <br />h� � � � <br />,��� l�P �� <br />�30+__.._—_._____ __�301'1 <br />I COPY OP THIS APPLICATION TO � I <br />BE POST�D ON JOBSIT[. i <br />CALL ENGINEERING DEPT. 259�BR11 �I <br />l24_ HOURS 8Ef-ORf: CONSTRUCTIO�d', <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />� spector's Si9na�� <br />�� 6�v-� <br />�ate <br />Note: Original to Customer <br />1 Copy to Pile 1 O 5�� <br />1 CopY to Inspector <br />� � i <br />�n:.vn (?�1 <br />. , .. , �• � i � <br />The undersigned owner hareby agrees to hold and <br />save harmless the City of Everett from any and a�l <br />claims for damages that may arise because of installa� <br />tion and maintenance of the improvement hereto <br />applied for and further a5rees to remove same upon <br />notice from the City and to replace public property <br />damaged thereby. / ! ! <br />�_ ii: i _ �� % , ""f t.� ��/�. <br />Signatu�� of Applicant ��...�.. <br />.�� . -. � Il. ! C C Iv �..i i� <br />AddrPss <br />' :' G t, I <br />Telephone Numher � <br />i , /' - � <br />! . i . <br />Date , ' ' ) <br />.� � �.-�, ,,,;� �� 7 <br />Fee <br />Dept. Approvals <br />Engineers <br />�i � ,� <br />Waterllov ✓,i.,+ /), ,�/Hov cc�- %,T . � <br />Street <br />Communica[ions � � -�� � ._�_ <br />;�- 1 <br />Traffic � l i - . <br />i �v <br />Plannina �C � � ;%�( ,"J_.:..���'f i:�/(, <br />� � K� l <br />ti<��:._ q! _ % -c.0 w z <br />Approved by ,; i <br />- i <br />Date Approved <br />