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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> �°efC" 10 4 5 4 li%�% <br /> e :�� � <br /> ���_s �� <br /> CITY ENGINEERS -- : ,1 <br /> EVERETT,WASHINGTON PERMIT N0. ' � � <br /> The Undersigned_ F � � ��� r� � r �E� -- �� <br /> Hereby applies for permission to Crnlf, Z ° � A ��/, . ���^/- o n >>, h l i C R��O __ �� <br /> At[he following loca[ion 7 2 �' !�! � c � �' — <br /> SKETCH <br /> (Work to be done) � <br /> /L � /L � <br /> i I � <br /> % <br /> �i� - - ------{-,� -f-� � <br /> ` t n� �. I II <br /> � �-19 I� i r � <br /> I � <br /> II � ( � \' . <br /> .�r�1<r �'�"L 2'' U <br /> 7Z12 , � <br /> � i` <br /> � � <br /> J <br /> I � l_, � <br /> i <br /> I � i <br /> t I <br /> � I <br /> , 4 J — <br /> 1`1u Scn �F I � <br /> i <br /> ��e'�..� <br /> DRIVEwAY SECTION � �r�/� � The undersigned owner hereby �grees m hold and <br /> rv0 SCALE save harmless the City of Everett from any and all � <br /> � Z 3� -- ---� claims tor damayes tnat may arise because of installa� <br /> � tion anA maintenance of the improvement heieto <br /> I" LIP <br /> � applied for and further agrees to remove same upon <br /> L30" —� .__ ..t.3���.� notice irom the City and tu replace,public property � <br /> �- -1------ � <br /> dart�,a,t,gai thereby. �� � <br /> —G���2_—✓/i�r7rtJc�� <br /> SignaWre o(ApU��cant � , <br /> � � i� v/�� ,�,rT—�___i�,-. <br /> � COFY Of THI£ APPLICP.I IUN l O � Il{j��:_i Aiidress � <br /> � ��L POSTED ON JO451TE. —L�'3 � 3 3 � � <br /> Telephone NumJaer <br /> , ,. I � i�lfJ! [RI � [if_Pl' 759�8l3i 1 _�_� . � 'J . <br /> Date <br /> .'., � �i t, I:1-IO ��'- C��.;. � ; I�.UCTIOIV� �� �� �<3�. _� )�c� �� <br /> CIiECK LIST Fee � <br /> Water Valve %pt. prov 15 yL!'Y"' <br /> Drainage <br /> Curb& Gutter Engineer6 1/ <br /> Sidewalk Water �� ���' /"J c':rSC� e ,G�J�� <br /> / � Streei�(,..:___ _i�— / <br /> I ( i .. � � �� � / <br /> ; ; . . ^; -,�.�'�. ___ Communications ., E� � � <br /> In;�iector's Signature Traffic - '� � � - � �^ � � ' � -� - <br /> Plannin- . �' � � <br /> —�ate . . . , --- $P a I• /� �' ��i� s.� P S o�. � <br /> Remarks <br /> Note: Original to Customer <br /> i co��- �o Fu� 1 fl G1 j � ✓ <br /> 1 Copy to Insper,tor Approved by / ��7/ <br /> ! <br /> Datc Approved <br />