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eye►pt <br />�e <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />APPLICATION FOR RiGHT-0E-WAY USE PERMIT <br />� PERMIT NO.�r�J� <br />The Undenigned l: � i ry i `— (��l i( �� J <br />, <br />Fiereby applies for permission to � nl5 z- � <br />At the following location �16./ � y Z'' �� ��� � � <br />(Work to be done) <br />S � :_ ,q r-�l�,v -"v <br />�RIVEWAY SECTION <br />NO SCALE <br />r- -- - - - -� <br />�_ {f, UP <br />�30'y _. �30" I <br />CUPA' UI� il! :� ,1I'i'LIi-i1 � Ili'n �l il <br />C�F PpS�I�GU ON J013SITL � <br />CALL ENGINEERING DEPT. 259�8811 I <br />7: FI(1URc r,EPORE CONSTRUC1lONI <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />In;per.tor'_ Signalure <br />�ate <br />Remarks <br />Note: Original to Customer <br />, ��pY « F��� 1 n 8 6 6 <br />i Copy to Inspector <br />The :mdersic�ned ownrr hereby agmes to hold and <br />save harmless the City of Everett from any and all <br />c�aims for damages Ihat may arise because of instatla� <br />tion and maintenance o( the improvemem hereto <br />applied for and further agrees to remove same upon <br />notice from the Ciry and ro replar,e pub�ic property <br />dain�r,ed t reby. ; /� <br />�l i G <br />Si9naWre of Ap�llcant / "— <br />��" Sls..� �f � � <br />Address <br />�.�.5 " (f �'�0."a <br />Tele h n u b <br />P��� �P �'�, <br />d- <br />Date — — <br />Fe �� �_, — <br />ept, qp rovals <br />!'' ' <br />✓j <br />Engineers �_ T � ,u= � <br />Ccmmunications <br />Approved by <br />Date Approved <br />