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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />eviren . 1 � 3 3 � <br />e <br />CI'l�YENGINEERS PERMITNO. �`S - /� <br />EVERETT, WASHINGTON <br />The Undersigned �'����? IL '' N �3���"�1 - �Z <br />Hereby applies for permission m ������T � �'�1 �� � `� � � � L- ���� . i ± l f �i <br />At the foilowing location � �'= � N� !1 � L �`_ +" � < <.✓U. <br />SKETCH <br />IWork to be done) <br />-Na�x�yr��i�; ���� <br />F_IIC� DF `._ai�T'(NL-' <br />;� !�•G <br />r�o�u <br />� � <br />ORIVEWAY SECTION �� <br />' NO SCALE <br />�. � � � --- --j <br />jl" LIP <br />�.so-i�,___ �_ —_-�.3--i <br />COPY OP THIS APPI_ICATION TO I,����' �'� J tL, U u 1��. <br />BE POSTED ON JODSITE. ��" �'(� '��.J <br />CqLI_ [NGIfJEGRING DEPL 2�9�8611 <br />�.2-0 ;'OURS f;�FOR[ �_i)NSTRUCTICN.� <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />:' : c1 i �.. . <br />Inspector's Signature <br />j <br />I <br />Remarks <br />Note. Original to Customer <br />1 Copy ro File 1(? 3 3 0 <br />_ 7 Copy ta Inspector <br />.a <br />� <br />....."__B C � <br />��. <br />� <br />The undersigned owner hereby agrees to hold and ��. <br />save harmless the City of Everett from any and all <br />claims tor 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 Ciry and m replace public properry ��� <br />Jign�w u� r�F!P am <br />�'�i������7 U. <br />Addr�s `�2' � <br />�s2-�an� - <br />Te�ephone Number <br />i/- /r- �� <br />Date <br />�,� � � � P. iilu� �� <br />Fee <br />Dept. Approvals <br />Apprflv��1 <br />�-!� �� �-.l ,L��C�/ /� ✓B %S <br />Da�e Ap roved <br />