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APPLICAI'ION FOR RIGHT-OF-WAY USE PERMIT <br /> ���«�, �. 10� �� <br /> � <br /> CITY ENGWEERS '7 �I <br /> EVERETT,WASHINGTON PERMITNO. -��`-� <br /> / <br /> The Undersigned .) i •�� S/��� N _;-�• %!� <br /> Herehy applies for permission to �' J �✓� 7�i ✓�- i`� �=, ! S� /-��j�51-!�—. �� ��Lc� _ <br /> At ihe following location �/2 P !� (�� %�/ IZ i U �� IJiC'. _ <br /> SKETCH <br /> (Work to be done) <br /> ,c./ � .) - . „ „ :�. � <br /> DRIVE WAY 3ECTION Thc undcisiyned awner heieby agrCes to holJ and <br /> NO SCA'_E save hatr,iless ihe Ciry of Cvcictt from any and all <br /> -- -- - --- ----� - -�i claims (ar damages that may arisr because o(insialla- <br /> tion and maintenance of the improvement hereto <br /> � —L' ��P� applied for and further agrees to remove same upon <br /> 4-30��.1.� r . ..-3`� •� notice from the City and m replace puhlic property <br /> damaged thereby. <br /> ,1� i�'1 5/i!/i�S a �i/ /':;.3 hL�;' /:.. �.N. �y' <br /> SignaWre of Applicant <br /> �.�f.n'i' Oi- �f I IIS ,-�;�Ni.l�i�i�l.r.: 1 U Address ---- <br /> fl[POS7 EU ON JOBSITE. <br /> ��.�U. [NGIP:EERINGDEPT. 7532t'.'�. 1 � TelephoneNumber <br /> , .. '��!=5 :3Ef OR[ i'.r,r,iSt RU(:Ti�:�f;I Date -- <br /> CHECK LIST Fee � �/Z '� - <br /> Water Valve 'D pt. , ppr Vals <br /> Diaina9e ! � ^ <br /> Curb&Gutter Engineers � � _ <br /> Sidewalk Water � <br /> Street <br /> Communications <br /> Inspector's Signature Traffic <br /> Planning <br /> �e - --- <br /> Remaik; <br /> Nutc: Original to Customer (+ - <br /> i CoP� to Filc � f �� ll <br /> 1 CuPy :u Insr:�,�v., -�- /�Pnroved by <br /> D;ilu APptuvcd __ .. � _ _ _ � �. <br />