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APPLICATIQN FOR RIGHT-OF-WAY USE PERMIT <br /> CVCi(n <br /> e 1012� <br /> CITY ENGINEERS �]�/� <br /> EVERETT, WASHINGTON,� ;�� � � � PERMITNO. � <br /> � , l: % / <br /> Thc Undersi9ned -t'-'"�l,+.f ', �.':;"�� . l.�i: . <br /> Hereby applies for permisiion�to 3S�'�� -°� �� •,L' Y�,,,-�-(_��/ (C';Ji(/,!;��T�1 I <br /> A[the following location � � ! 7 �L`YMPI C D/2. �q w 13 : <br /> SKETCH / I <br /> � (Work to be done) / , <br /> � <br /> .� 40� <br /> � --NFI;v ���/;'��:rTE � <br /> � Dr?I I�EWAY <br /> �,� 1 <br /> ,; <br /> 4; !�%'%� r+� <br /> � - � , < � <br /> =%= � <br /> .:,./j�� 6r;.�9 � <br /> � \ ; <br /> / ��a\ \ ��j � <br /> � <br /> �� e <br /> 0 / �\ � <br /> / \ <br /> Pf�MEN7EX15T� I <br /> � / <br /> '� <br /> � ' u„������ �� ��� t , , �, � � \ <br /> G(/,t<t � �•, �,� .� � � � <br /> � <br /> "� /' S�.<�,< <• ., ��, s /e <br /> 1' i 1� �-/9 �5;� <br /> DRIVEWAY SECTION � The undersigned owner hereby agrnes to hold and <br /> . NO SCALE � save harmless the City of Evere:t from any and all � <br /> � � claims for damages that may arise because of installa� <br /> f----- . ;�S . <br /> �— �i" �ip - -_�' tion and maintenance of the improvement hereto <br /> � applied for and further agrees to remove same upon <br /> 30" �---,� � 30" notice from the Ciry and 'o replace public properry <br /> 1- -{�— � ; __-}-- - <br /> ' dam�ap�ed thpdreby. � <br /> ����,�1:) T/»Li,..i . <br /> Si na�re of Applicant � �. <br /> /;-G��a--�%y <br /> �:OPY 01- THIS APPUCATIUDI i i�� Address � <br /> ���';- �'OSTED ON JOBSITE. Cj t' 'Z — .5` S� 3. U <br /> (:�'��f I �;!'JFERIf;G DFPi. 25&881 i � TelephoneNumber � <br /> i �'� ' �� . '�:I_I �� .�i��PJ:iTR,UCTIOIV�, ��'� -��� Date —��� ��� <br /> ✓ ' -i ;'� ' _ �n � ,^ <br /> CHECK LIST Z� -- /�--'J <br /> Wator Valve �� Fee <br /> Drainage Pept. Approvals <br /> Ci�rb&Gutter En��neeis � � �`LL��iJ I �/ �S` <br /> Sidrwalk `��Water-���/ <br /> ��� i' ' ; '�" i 'i � Street ,(;��= .'�.....� <br /> / ' � / , <br /> , . . �� , :.:�L. � Communicatio�s -.�'.-�F.% .�1-..--....a-v _ i>-zo . <br /> Inspector'sSignamr� Traf(ic� !L�J,uy� 1:��. 7g' <br /> ,. � . . Plannirig - . �� r �� /A�.J Z l'Z�7��..-. <br /> �Gate------ <br /> Remarks <br /> Note: Original to Customer -� <br /> 1 Copy to File ���� � — <br /> 1 Copy lo Insprctor Approved by i % <br /> � <br /> Datc Approved /�/'�,— 7 � <br /> �� J_�•J, � <br />