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APPLIC�i ION FOR RIGHT-OF-WAY USE PFRMIT <br /> everetl� �O�C q <br /> ,� V 1 <br /> CITI' ENGINFERS . �� � � <br /> EVERETT,WASHINGTON PERMIT N0. 7 <br /> The Undersigned L�Y �/ f i+��1"/ 'v '' � 'J�-�'� <br /> Hereby applies tor permission to/ � ���� ���� T � �� 7-:�� �.�S/�',Y��..` ��/vJ <br /> \ <br /> At the following location��/�y ? "-� `v-1 i ; � r' _ ' <br /> SKETCH ,��`� <br /> (Work to be donel , ! � �I <br /> � ' � �.. <br /> � rjr e l�Ti/�CF+�=i7 I <br /> I <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 /> f. --- --- -� claims for damages that may arise because oi installa� <br /> T + „ `1P tion and maintenance of thn improvement hereto <br /> � � applied for and further agrees to remove same upon <br /> �_3o'�,f� _ , .____ _ _ .�3��� notice from the City and to replace public property <br /> damaged thereby. � <br /> %. )��_ l� ov2(ii �� n . <br /> SignaWre of Applicant <br /> n' �1: 7 ` `� iT <br /> ' ( �� � � , �i IIII:; ,:IJ'I �.,�.-�: I� ��: i ��- Address <br /> S � n' S2Z <br /> �!E POS�T6U Oh JOBSI-i L. � Telephone Number ' <br /> ,.nLL ENGINEFRING DEPT. 253-8817 �� A��:-aQi' N 3 I l 5'J 7 __ '� <br /> .�t !Ii;uRS (?f.iORFcr��r;;rRUCTI j Date � � , � <br /> �� t �\ � � , ��'— �` ,t�l� <br /> CHECK LIST � 1 ���� ��' Fee <br /> waier varoe , i�;�, Dept. Approvals <br /> Drainage ' �� <br /> Cur6& Gutter <br /> Engineers <br /> ! Sidewalk Water /� � !Y+ ' � . �-� %� <br /> . / S[rcet ��� � � <br /> 1 <br /> � Communications <br /> Inspector's Signature Traffic <br /> � Planning <br /> � <br /> –bate � � � (� � ,. : r ; . ..� /�•>, 7��r y�.__ ,��a E. ._ <br /> �n�1�;',{ � ,7_ �S __�__— <br /> a <br /> �;� � – <br /> Rema Y. ' <br /> � <br /> Note: Ori�i� I�to Customcr � <br /> , �0,>�4�F��� 10761 <br /> � 1 Copy ro Inspector Approved by <br /> � Date Appioved <br />