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everett <br />e <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />The Undersigned <br />Hereby applies for permission to _ <br />At the fu�lowing location �- i: �' � <br />(Work to be done) <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />r,o .,3,0 <br />: � � h <br />�_.._� L: "-__.. <br />r. . } _, _t-, <br />1 \� 's" ,,>:�_: <br />-- -- -�T 2�---- - - <br />� <br />1G�598 <br />PERMIT N0._��=. <br />� � t <br />' _i <br />, _ <br />_ ..- � <br />_ _ __ _ _ - , <br />�____ _____________ � , <br />� DRIVEWAY SECTION <br />NO SCALE <br />� � <br />���� LIP � <br />30'�__ ___. _ _ ___ I 30 I <br />—�(• —•1 <br />COPY OF THiS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />I CALL ENGINEERING �EPT. 25�J�8611 '� <br />I�4 IIOURS �EFpR[ CONSTRUCTION I <br />l� l�i <br />ate <br />Remarks <br />Note: Original to Customer <br />1 Copy to File 'i ("I h�� , <br />1 Copy to Inspector � - <br />' <br />r'. , 1 , <br />The undersigned owner hereby agrees to hold and <br />save harmless the Ciry of Everett from any and a�l <br />claims for damages that may arise because of installa• <br />tion and maintenance of Ihe improvement hereto <br />applicd for and furthnr agrees to remove same upon <br />notice from [he City and to replace puL'ic properry <br />damag@d thereby. ,� � .` � - �- , / <br />l���ir"-.l _�/':,//1�,T <br />Signa re o( pp�icant . . <br />, . . I ! � / � .. � .:. -�.. ��f �� � . <br />Address <br />� % <br />Telephone Number <br />Dept. Approvals <br />r <br />Engineers� . �� <br />; � Water <br />�.Street � � � <br />Ccmmunications � � __ � �� , <br />h Treffic_ � � � <br />� • <br />��Planning � � �' �/ i�%//j � i �! <br />, <br />Fy�pioved by . "'.i <br />DateA�,prrncd ---- -.�_'--'- ---�---"----- <br />