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evcrett <br />� <br />CITY ENGINEERS <br />EVERETT, 1VASHINGTON <br />APPLICATION FOR RIGHT•OF-WAY USI= PERMIT <br />ZI)y38 <br />PERMIT N0. ' '� ' �� � <br />TheUndersi ned �� ������" � �� ' <br />g (. , J ,i; f. �r: � <br />Hereby .ippiies for permission to ''-ii��� r �; i.l,' J� ,q �2G �: ;r.�. � i'r; • � �i % <br />At the iollowing location 2� /' 3 A/1. k/� Ti"n /3 ��; . � _(,�� �! , _ <br />SKETCH <br />1Work [o be dnne) <br />S4 f. /}~ % i�'� (. h t= `' <br />�RIVEWAY SECTION <br />NO SCALE <br />I+--- ---- -� <br />I" LIP <br />1�1� �Y3O„ <br />COPY OF THIS APPLICATION TO I <br />DE POSTED OW J0651TE. � <br />CALL ENGIN6ERING DEPT.259�l3817I', <br />24 HOURS BEFORF CONSTRUCIIUN � <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Signature <br />Note: Ori9inal to Customer <br />i canv �o F�i� 1. r g�� <br />1 Copy to Inspec[or <br />Y' <br />The undersigned owner hereby agrees to hold and <br />save harmless the Ciry of Everet[ from any and all <br />claims for damages that may arise because of installa� <br />tion and maintenance of the improvement hereto <br />applied (or and further agrees to remove same upon <br />notice from e Ciry ai d to rep�ace public properry <br />damage �. <br />l�.-c7 <br />Signature of Applican / <br />%�O / �1 E. �T �o �+-� <br />Address A, / / ',/ ^n <br />/�/!/K//7�+J (/f/�i. 7pZ%J <br />Telepho�r , mber <br />b��fU�-� i -�`S .S`�// 'rJ � <br />Date <br />hee �-�i.::� � � /p�`�. <br />Dept. A provals <br />�' /�� ��'i <br />Engineers , C ;��-� � __ <br />� <br />Ccmmunications <br />Approved by <br />Date Approved <br />