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t� <br />���«n <br />� <br />CITY ENGINEERS <br />EVF.RETT. WASHINGTON <br />The Undersigned _ �%L i.�- �J� <br />Hereby applies (or perinission to <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />s <br />Atthefollowinglocation �5,.=7�%;'�' `=T- /_o„ti.!.r-� <br />�,, _ <br />(Work to be done) <br />�RIVEWt.I SECTION <br />NO SCnLE <br />r- -_ _ ---1 <br />� +P' uv <br />r30�,- --__ __-_ -.1.30..I <br />'�COPY01= fH1Gl,P4-:JGA:110`J i0 . . <br />' r>G POSTED ON JOBSITE �I <br />U,1LL [NGINEERWGDEPT.2ti9�R811�� <br />..����URSIr.EI��(ll � .11�.;�r'�,i�1'�.;� <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Si(ewalk <br />Inspector's Signature <br />�te <br />Remarks <br />Note: Original to Customcr <br />1 CopY to File ,. ��� O <br />1 Copy to Inspector <br />F ii�: �a. �t� J <br />S -�:- <br />1.�060 <br />PERMITNO. �%� /�J � <br />The undenigned owner hereby agrees to tiold and <br />;ave harmless the City ot Everett frnm any ancl all <br />claims for damages that may arise because of installa- <br />tion and maintenance of Ihe improvement hereto <br />applied (or and further agrees to removc same upon <br />notice from the City and to replzce public property <br />dainaged there6y. <br />/����.� �-. _ «,1� .0 • , . <br />Signature of Applih i�- - <br />9v i%,.'i-ia,vi% ,�-Yu`� .r;,',,q,v„ <br />Address �•a•>�!J <br />�'��.- 77,�'S <br />Telep� b�/ <br />> <br />Datc � ���x� <br />r/ <br />_{�:'-�' ':#� <br />Fee <br />Dept. Approvals <br />' r . <br />Fngineers___.��:_�'P�� � <br />Commun <br />PI <br />Approved by <br />Date Approved <br />