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everetl <br />� <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />The Undersigned ll'1. l+�'�. /I'� i 7:tK % <br />Hereby applies for permission to /�/ r�G. � S Cl �_� ,= /7 � :' � �.�'.�1,' " j, <br />Atthe foilowing location /,�// �!!�, rC i! 1�v � J !��(.,VJ <br />SKETCH <br />(Work to be done) <br />SF F R.� %��i��0 <br />ORIVEWAY SECTION <br />NO SCALE <br />� � <br />1�� LIP <br />�34�—_—_—_—_ —._.4.30...I <br />� COPY OF THIS�i.PPLICATION TO I <br />B[ POSTED ON JOBSITE. li <br />CALL ENGINEERING DEPT.259 Rti! l � <br />:a i�ourts r�Eror;E cnvsi�i;ur��i��ra'�� <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />�aie <br />Remerks <br />Nole: Original to Customer <br />i conv �a F�i� 11075 <br />1 Cupy to Inspector <br />Z1o75 <br />PERMIT NO. � � 3 �O G <br />The undcrsigned owner hereby ac rees to hold and <br />save harmless the City o( Everett irom any and all <br />c�aims for damages 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 City and to repl�ce public property <br />damage rebN._ A <br />%U 6A' <br />Signawre of Applicant <br />�o �r �; �r ,r, L T,� ,C�.�v ) <br />� <br />Address ,� <br />� `v�--��' � 17/.9Sf/ 9'0°703 <br />Telephone Number <br />_�mll 2/ i% <br />Date <br />Fee /�/,� t': <br />Dept, ppr�als <br />Engineers �J � �,te, !' <br />Water_ <br />Communications <br />Annro�ed by <br />Da[c Approved <br />