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APPLICATION FOR RIGHT•OF-WAY USE PERMIT L' <br /> everclt 10 4 0 5 ,�/", � <br /> e � 3��� <br /> CITY ENGINEERS "`.,J ' G,��0 <br /> EVERETT,WASHINGTON PERMIT NO. <br /> The Undersigned_ � �'����� �- �'� '-- �'Ui1/L�,/"S <br /> � Hereby applies for permission to �n�s� '-..��-+ �/�P��L� �v�" — <br /> At the foilowing location %�� L� �n •'`t✓�N�-�G� <br /> SKETCH <br /> � (Work ro be done) � ��T�C�]�/ <br /> � <br /> — _ >� � � <br /> �� <br /> ,` � <br /> i � <br /> ;�✓� —�c_ . ��• �.,, .,-�; <br /> � ,' , 1 <br /> _ �,� . .i.) <br /> ��` ' � <br /> v <br /> , � <br /> °� � ,I <br /> ; <br /> �� , <br /> . ,�. � <br /> ,�, <br /> �,l <br /> � �r' � .c,e <br /> L�r �� <br /> i � <br /> CC;-v�,- .-3�•%-�,�Gr i;-v ' V <br /> ORIVEwAY SECTiON The undersigned owner hereby agrees to hold and <br /> NO SCaLE save harmless the City of Everett from any and all <br /> �— — /,j� -- -- - � � claims for damages that may arise because of installa� <br /> �7�1 tion anA maintenance of the improvement hcreto <br /> (I" uP / I 1 r� I� '�II ,�' �� applied for and further ayrees to remove same upon <br /> �..3�'�.--l---�30� �� _,�; no`ce from the City�o r ace p lic property <br /> � <br /> � ���� dam�c�therebp: <br /> � f��� ���r� Signat�e of Applicant ` <br /> � �r� / �// /L �'i./L/t/i/V <br /> �� COPV Of THIS APPLICnTION T0—�i Add ess <br /> , BE POSTED ON J0651TE. � �� `� - 7j�� <br /> � Telephone Number <br /> �CPI L ENGINEERING DEf'T ?59-3H i I __ <br /> � '71 ��-Uii:' ��FCRt.- (�.r ,11 �''.11�i�. � Date .��� <br /> / �-° Qf 3 >�i� <br /> CHECK LIST Fec <br /> Water Valve Dept. Approvals <br /> Drainage � 3 <br /> Curb&Gutter Engineers 6 <br /> Sidewalk Water .��. d�r �Pei�Sc.lP .�$!,3 <br /> ��t�� �� Street :�_� <br /> Ccmmunicati --� <br /> Inspector'sSignawre Traf(ic ��- . <br /> � <br /> Planning �"� � � <br /> �te <br /> S wP�I- .0 .-S.(B. <br /> Remarks <br /> Note: Original to Customer <br /> t conv lo F�i� l0�n 5 -JC/� / <br /> 1 CopV to Inspector Approved by �, . 3�� <br /> � � <br /> Date ApPro <br />