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�����n <br />e <br />CITY ENGINEERS <br />EVERETT,WASkINGTON <br />The Undersigned -%�-J L L <br />Her?by applies for permission to <br />�j , „ '., i,�ld�I <br />APPLICATION FGR RIGHT•OF-WAY USE PERMIT �G 5 <br />1�355 ,�Ij�i ��'L <br />�� <br />, '' , �►.�� <br />PERMITNO. /'_. " /. <br />_..r� �i <br />/ _ /:J' , /-: �1, . � <br />AttheFollowinglceatioo ,=•-�;�> ` L���L"'.J.���--� —'� �=�� <br />SKETCH <br />(Work to be done) <br />�i;�T� <br />i�= [�;: yT - r .l':1J� <br />C_ C/G I�F,�T i 5 L. —',.;i <br />1�('/ll� !�✓�C�G ��, <br />J C-? - C�/ 3.-5'.tJ <br />_:i:. c:� ;:?`,� ,'�'.5-.'' <br />.�-. __ c.;�� �. <br />�RIVEWAY SECTION <br />NO SfALE � <br />�i�fl� � <br />11„ LIp� <br />�30�____.-_ _�_30 I <br />.� <br />�� COPY OF THIS APPLICATION TO <br />EE POSTED ON JOBSITE. <br />��4; L F[dGINL-EitIPJG DEPT.25&8;:�'. <br />". II[�Ult; [3EFf�i�G C(iN6TPUC� iCC�I <br />v�/ <br />� 1 <br />� <br />// � � . <br />� <br />�` V <br />1 <br />��\, <br />�\ The undersigned owner hereby agrees to hold and <br />�� save harmless the City of Everett trom any and all <br />claims for dam2ges that may arise because of installa- <br />tion and maintenance of the improvement hereto <br />applied for and further agrees to remove same upon <br />notice from the Ciry and to repl�ce public properry <br />d maged lhereby. <br />� '� �_ �Z�_ _G�"-.z_.��� � L_�_,,._. , � <br />$ignature of Applicant <br />� �L.: � ir. �_ � i��-�� ,r . � <br />Addrese y <br />� � �'�,,., _ , y��' %G. . _ � '..S" �- � _; <br />Telephom� Number � , <br />��� /�c _s � <br />/-,'_�� i <br />Date . � <br />� �—T�Z� <br />Fee <br />CHECK LIST <br />Wzter Valve <br />Diainage <br />Curb & Gutter <br />Sidewalk <br />/ . �' ���/ ., , � <br />I ector'sSignature <br />�_ �y` -'/c;_. <br />�ie <br />Remarks <br />�p.'v' ,.. <br />Note: Original ro Customcr � <br />1 Copy to File 10 3 5 5 Approved by � <br />1 Copy to Inspector ��� — �.�� <br />Date Approved <br />