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i���cr�•tt <br />� <br />APPLICATION FOR RIGHT•OF•WAY USE PERMiT <br />1.�_395 <br />CITV ENGINFI:Nti <br />EVERETT,NJ�SHINGIt)N P[RA711 NU.____.. _�: <br />. � . �: r, -- � <br />� <br />TheUndcrsigned �'��. �l�rL� - �_ . _r � <br />Hereby applies (or permistilon to _ � � �y_ F., � �, � . !� - <br />At tbe tollowing Iocallon ��j 1;j �v� i�F�+L� . R� u�� <br />(Work to bc donc) <br />��� <br />+�° I <br />��, <br />,i : <br />9�+� '! ' _ . _ <br />DRIVEWAY SECTION <br />NO SCALE <br />� � <br />I" LIP <br />( 30'� , � 30" <br />�- <br />cnPY OF THIS APPLICATION TO <br />(:c POSTED ON JL�BSITE. <br />:ALL ENGINEERING OEPT. 259•8811 <br />: 4 HOURS BEFORE CONSTRUCTION <br />� CHECK UST <br />Water Vatve <br />Drainage - � <br />Curb & Gutter <br />rSidewalk <br />�' <br />Inspectqrs ignamre <br />/ <br />(, - r9 i'k' - % �) <br />Date <br />- � ------ ---------.. _..-- <br />fi�.�rnei�'.s <br />� : � r, <br />,� <br />r; <br />� p.,-' .'. ... .. <br />The undersigned owncr hereby agree•. to ;�old and <br />save harmless the Ciry ot Everett irom any anA all <br />claims lor damages that may arise because oi mstall�� <br />tion and maintenance ot the improvement liereta <br />applied for and turther agrees to remove same upon <br />notice from the Ciry and to replace pu6lic property <br />dama5ed thereby. , <br />Signature oLApplicant � " -� = <br />�� � <br />Address� � �i`-�i:w.'4',�� �Krti� <br />� _.,�v�/f <br />Telephone Number <br />Dat'L�' ?k <br />Dept. Approvals <br />Engineers � <br />Street ' <br />Communications <br />Traffic <br />Planning_ <br />_ • <br />nrproved by , � .. 1 �, <br />f),rtc APpioved ` � / � , `h4 � 9 <br />