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_ everetl <br />� <br />CITY EIJGINEERS <br />EVERETT,W'ASHINGTON <br />APPLICATION FOR RIGHT•OF-WAY USE PERMIT <br />��22� <br />PERMIT NO. �� —( O <br />The Undersigned � ? � L � —�� L� <br />Hereby applies for permission to ��ONS T.PN/'T 2 /J ' AJ�/J.�IGT ! f��/ � <br />At the tollowing location ��i'�o� � ���1�-���� <br />tWork to be done) <br />� <br />� <br />� <br />342 I <br />������� <br />M �� _,- <br />I � I <br />DRIVEWAV SECTION <br />NO SCALE <br />t'-----Z-�.J � ��� <br />�I�� LIP <br />30'�„__—. G'/ �i _ I 30 � <br />T <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. ', <br />CALL ENGINEER�NG DEPT. 259�R8t t <br />�a taour�s ��r-o�� coNSTr�uc�iu�i, <br />CHECK UST <br />Water Valve � <br />Drainage ' <br />Curb & Gutter � <br />$IdC,v,�BtK <br />-,./� ��^ ' �_�/' i �'/��( ��.� , <br />� <br />Inspector's Signature ' <br />-Nfln/ f�1SPNAL T <br />D,�i uEi�✓r� s�s <br />� <br />� �D <br />� rE; luATe.2 .�,Pvice � �� Lo�.4T� <br />�Fv,PE Cb.vsr��TiaAi ,� �iv€�Ay <br />-; <br />i � � ' c � <br />ate <br />i� <br />%i%1 ��� <br />Remarks <br />Note: Original to Customer <br />t Conv io Fiie �. [1 L`%. 0 <br />1 Copy to Inspector <br />4'.. .' <br />�w <br />I�T <br />ND �C/�L E <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and all , <br />claims tor damages that may arise because of i�stalla- � <br />tion and maintenance of the improvement hereto <br />applied (or and turther agrees to remove same upon ' <br />notice from the City and lo replace public property � <br />damaged tl ereby. L� � <br />� <br />Signaiu of Applicant � <br />� v 2 / /N a �.�,1 i�L-� /J <br />Address <br />� S ,' _ vio � <br />Telep �mbe�( � r <br />Date � � <br />/S, on /��f' , /G - � � �I <br />Fec <br />Dept. Approvals <br />Engine rs��"`�'�" ' � -� � <br />'� Walcr l -c�C)-%� . <br />i . <br />$trCeL �'' <br />Communication��•� a�' F' �-��-%1� <br />Traffic " � ?� <br />Plannina ' '� � 1l/L � �y/7L � <br />APP�I'�dF �PL�,i/..tLt�F ln—L�t-,%%' <br />T�� <br />Date Appfoved � <br />