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APPLICATION FOR RIGHT•OF-WAY USE PERMIT <br />everett - � O O C � <br />'� J <br />qTY ENGINEERS ' // _ <br />EVERETT, WASHINGTON PERMIT NO. `T� <br />The Undersigned �� !'i � �\ Y{�� J <br />Hereby applies for permission to _/�I/.S TF� L L R�l�fr�/9GT A�� /�.!/S l� f1 L L� Y <br />At the toliowing location 3�Q 3 1 V�1 �S /n L� <br />IWork to be donel <br />�� <br />� <br />0 <br />2 <br />N <br />M <br />DRIVEWAY SECTION <br />NO SCALE ,�---' <br />� �• � <br />� IP <br />� <br />�30¢__ __—.—__-__—_�30 I <br />.y <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL [NGINEERING DEPT.259-8811 �� <br />24 HOURS BEf-ORE CONSTRUCTIONI <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />FJo ScAL6 <br />APRaNs -(o Re FEATHERt�A <br />zo� �, <br />��/ <br />�GLJ C� <br />Slq6 � <br />3203 <br />NASSAU <br />�C:,� `�,,,,:� , �a-� -�y <br />Inspector's Signature D �'r <br />/� <br />C�'ZU'—I!I <br />ate <br />Note: Original to Customer <br />i Copy to File <br />1 Copy lo Inspecmr <br />ST <br />rZCc�D <br />A�-�-EY <br />• The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and all <br />claims for dama9es that may arise because of installa� <br />lion and maintenance of the improvement hemro <br />applicd for and (urther agrees to remove same upon <br />notice trom the City and to replace public property <br />damaged thereby. <br />.. �� r�__ `ZLL . <br />� Signature of Appli\can' <br />.3 .� (`� � N f� ve n . <br />� Address ` <br />��2—J7C�J <br />�� Teieph ne Number !, <br />"� Date�—/�— �T <br />!�( O i= F l= <br />Fee <br />ly„ Dept. Approvals <br />�, -� Ec, <br />���,��e.� 9-17-�4 ('_,,,. i4,,,,, �;-,_�, ;�� <br />Water_ �_ <br />Communications_ <br />Planning ;�w.r �>-! <br />1 " " � � Approved by � <br />i <br />Date Ap� -- j j <br />� <br />y�`.;� ;,�, <br />