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� evi�ren <br />� <br />qTY EfJGIN[ERS <br />EVERETf. �VASHINGTON <br />The Undersignetl 1'/`�J,�:�_� <br />Hereby applics for permission to <br />APPLICATION FOR RIGIIT-OF-WAY USE PERMIT <br />At the folluwing la:ation_;:'=-�r' <br />(Yloik to bc done) <br />ORIVEWAY SECTION <br />NO SC4LE <br />r� —. ._ __..— ---- - ---`� <br />�_11" LIP � <br />�'°:{-- �-- -_ _ _ .._ --�-'�'�I <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOOSIT[. <br />CALL ENGINEERING DEPT. 259�8811 <br />24 I10UR5 BCFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Orainage <br />Curb & Gutter <br />Sidewalk _ <br />Inspector's Signature <br />�ate <br />Notc: Original to Customer <br />1 Cepy to File 110 5 2 <br />1 Copy to Inspector <br />11 G5L <br />., <br />PERMIT N0, '' � � ' � �/ __ <br />—�-- — <br />i`rt��rlG3 ._._ ._ <br />The undersiyned owner hereby agrees to hold and <br />save harmle;s the City of Evcrett from any and all <br />daims for damages that may arise because of install;r <br />tion and mamtenance oi the improvement hereto <br />. pplied for and further agrees to removr, same upon <br />notice from the City and to replace public property <br />dama�ed thereby! ^ <br />1 )Q ��� - <br />6i�nature of A p 'cant � � � <br />�d�4 � <br />s L� L.i __ /�1_���s 1 <br />.S_F S' JSo� '`�'�b <br />Tclephonl Number � <br />—�-%�_r2 S_�� <br />Fcr. �ir� i�.�. �:� -- - <br />Dept. Approvals <br />.7 . <br />Enginccrs ::__� ���'� <br />Commun <br />Planning _ <br />/�ar/S ,- ��i..-.1�7 .� <br />,�_� <br />Approved by <br />n.,�� nnn,:-.•,i,d <br />