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evcren <br />� <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE FERMIT <br />10424 ��/, <br />�'�'�j�� <br />PERMIT NO. 7G� '-' C `} <br />The Undersigned ��� r� r' t-1 i o h c' n n F 5 c �-� <br />Herebyappliesfpppermissionto_ GOnCt��i�Y' a 4?'� 1',-.-,��. �� .',. �'_.._, i.-� .. .� c/ . <br />At the following location / 7 n / /v/ j��� � �// � V e� / �--- <br />J <br />SKETCH <br />(Work to be donc) <br />� <br />, <br />� ��� :� <br />N <br />4 <br />� •:. <br />" 22�C <br />Q� <br />� ~ �1 �_ <br />�l <br />bRIVEWAY SECTION <br />NO SCALE <br />�_ I' LIP -� � �-�� � � <br />�34��.__.. ._—__ _-__�.30'.� <br />� i:OPV OF THIS APPLICATION TG � <br />GL POSTED ON J06SITE. I <br />� CALL Lf.GIPF�CRING DEPT.25&BAI i <br />; a f�ouNs eeri�r�E con�s � i;uc � ��,ni � <br />CHECK LIST <br />Water Valvc <br />Drainage <br />Curb & Gutter <br />SiAewalk <br />Inspector's Signature <br />Remarks <br />Note: Original ro Customer �f <br />1 Copy tu File 1_ �j �t ! 4 <br />1 Copy to Inspector <br />H 1 i �- .; <br />�1E:rencc Shuuld ,%v� �i�t�rfPre w�1h I'Ae <br />rePn�� nr repinC�mFr,t c/lf,t :crr�c� <br />l,iri l'C Y�ic l�ou:�� �;1 /flt p/��f���1017'-�.�f� <br />J <br />` /_�_ <br />d� I re,-,c.< : � /7r'y 5% rhn,./A be a./ <br />���,:r � e,.<k �r -i +r,.,,�.�i <br />�`if�trr l:np. <br />wn *� r� <br />�7 <br />�.�..n ,a�_._.______'_'_-' __"__ <br />: a' f . .i A� , r <br />M< Do� �ol�_ /�vc <br />P/i7 1' n s�4 1e <br />��r.�` �/,/,� <br />[ � <br />��3. �., <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett irom any and all <br />claims for damages that may arise because of installa- <br />tion and maintenance of the improvement hereto <br />applied tor and further agrees to remove same upon <br />notice f�om the Ciry and to replace public properry <br />damage thereby. �j�/ i <br />> S-l� /f��G!/J�t`Y�.l�S.I'/l�� ' <br />Signaty of Appl�Tnt <br />Addre s / / <br />,. ,�l; �� �J7� G� l. < <%i c� �l lf�l,! � <br />_{�f <br />Telephon N mber � c7'--' - ' <br />.� � ` - �v �5` 3� ' <br />Oate ' � <br />_—_j��'7 1- r L - <br />Fee — <br />De t. �9pp�v Is � <br />Enaineer � �� <br />Water o Q.ti Gei� S �-y.� �? <br />Strcet_ A�ii� ' �,f � <br />Communications <br />Traffic -� � �' � <br />Planning� � ' �%�� . <br />S�?�i,vr_ �j(C, �lls+.ls'oy _1_ .f3 <br />i <br />ApP�ovc � <br />4 � %� <br />� Dat Ae pproved <br />