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APPLICATION FOR RIGNT-OF-WAY USE PERMIT <br /> everett 10 2 4 5 <br /> e - <br /> CITY ENGINEERS ` � <br /> EVERETT,WASHINGTON PERMIT N0. �� - � � <br /> P � <br /> The Undersigned �� ��L L � •� � � �-_�-.' ' � ^-/ __ <br /> Hereby applies for permission to CQ/V.S�T,?l1L'T /-). .G l � .A/V� %-1 /S�' fl5%�N�.IL J� <br /> D R/f/E In//-�Y <br /> At the following location�����'��+-B �--�i- ���� �" � `� �� �i. _ <br /> - L C� �" /�) <br /> SKETCH I�V <br /> (Work to be done) � <br /> � t�X IS T'lNG �Ur>c �Ji= i'V,{i 1• --� <br /> � <br /> �1� I dl � ��'�� ' � T iYJ�I L;//S. <br /> i '' ,-, -- <br /> �:����j <br /> I .� ���, �'� <br /> ,.,_._,, <br /> •� ,,;` . � � : ,'t;. D i.4/'S. —.�i ; � � y <br /> � <br /> I�r \� � -- � � e <br /> ,v. ;;�� <br /> � ��L' <br /> 'J I <br /> �?� � /� <br /> �� I <br /> � <br /> Ald 3C�LC �O� — <br /> 7= <br /> , <br /> �. DRIVEWAY SECTION 1 The undersigned owner hereby agrees to hold and <br /> ��. NO SCALE save harmless the City of Everett trom any and all <br /> r--� � - -Z�:�5`----- - - -� i claims for damages that may arise because of installa� <br /> �f' LiP Q��- � tion and maintenance of the improvement hereto <br /> --� � i 30 I -`� ' � applied for and (urther agrees to remove same upon <br /> �3�':�.. �� - �D ---.4.-��.� noti e from the City and ro replace pu6lic prcperty <br /> a ayed thereby. <br /> L ��'��,.� l�'_�9�,.c <br /> � igniture of Applicant <br /> ��a7_ ,�F����� ,v r .� <br /> Address <br /> � cOPY OF THI;APt�LICATION TO I U.E�E�i, <br /> ��.-;E POSTED ON JOBSITE. �. � � S� - �C,L3.� QdA'a7 ' <br /> � ' � i� ��� �; IJ � ,1 � Telephone Number <br /> �_:�.,_i. �r.cir�irr_nir,coErr. zs�-aaii i 1J ] iP' 7 —��- 75� <br /> , '4 li���!li:; i�i-.ff!itL CONSTRUCTION � � /� �!� Date /'�. Dn ��� �i�. 7/Z}/71 / <br /> ✓ t' <br /> CHECK LIST Fee � � � - � � � <br /> waier vaive r�'� /�� �� Dept. Approvals <br /> Drainaye � -� lJo / dp� 'UG OC/cY ;,(Jq,cl' , <br /> Curb&Gutter ' ! 1 �/?� Engineers �"• � ��� � " �' ' "-''t . <br /> Sidewalk S 7� f � T�+ W�er ��2 2 '7 <br /> � <br /> _. � Street���.�.- . <br /> ^� -I ��. � .�.,tD- 7-zi- �'_�� <br /> I <br /> � r �'i,' ,i I . . <br /> '� � . i '�,� • Communications <br /> Inspector's ignatum Traffic �'-�V Z �, �-` <br /> . . . Planning / , � '%. ,I 7 7� <br /> , <br /> ate <br /> 7 <br /> Remarks • <br /> Notc: Original to Customer <br /> , ��,,Y �o F��� 1.p?_ � 5 � <br /> 1 CoUV tu Insper,tor APP��o�db��� � '�„�� //�: ;. l.0 r.i �^�� °�� . <br /> , <br /> Date Approved <br />