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� c�cren <br />�e <br />CiTY ENGINEERS <br />EVERETi, WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />"11022 <br />�, -� <br />PERMITNO. � � 3 Z ' <br />/ <br />TheUndersigned 1/��;:=i: - :,rT <br />Hereby 3pplies for pertnission to •"ON tY�°UOT 3 - ?S � ��P .i � � ,' i.', d � ..; � �/S <br />� <br />At �he tollowing location 9�11 � °/ =�� ra v% l�/ !�__ - :��- � <br />(Work to be done) <br />G,',;" r� i .'; �> /� '�7 <br />�(iIVEWAV SECTION <br />NO SCAIE <br />--- - –� <br />�'� LIP <br />�,.3��.1... . . . ..._ ..�..30��. <br />�. �, r <br />Ilk_ POSTFD JN JOIiSI iL <br />C�LL ENGINEERING DEPT.259N^7 ! <br />. �" ��:�'.�_�i75 REFORC_ CON"Tf2Ut�ilrih! <br />CHECK LIST <br />Wate� Valve <br />Drainage <br />Curb & Guttcr <br />Sidewalk <br />Inspector'sSignawrc � <br />–6atc --- — ---- -�— – <br />Remarks <br />Notr,; Originel [o Cuslomer <br />, ���Y �o F��� 110 2 2 <br />1 CopY to Inspector <br />u <br />The undersi9ned owner hercby agrees to hold and � <br />save harmless the City of Everett from any and all � <br />claims for damages that may arise because of installa� � <br />tion and maintenance ot the improvement heieto . <br />applied tor and further agrees to remove same upon <br />noiice from the Ciry to repl e public properry �. <br />damaaedtl�rebv. //%i /�—..1 <br />– �� <br />one <br />Date ' <br />�3 7 `= ' �,� � 3 /i� /. �s <br />Fee <br />Depc, pprovals <br />7 � <br />Engineers ' <br />Communications <br />Planning <br />Approved by <br />Da:e F.pprovcA <br />� <br />� <br />