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evcren ANPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> � 10961 <br /> CITY ENGINEERS ^7 � <br /> [VFRETT,WASHINGTON PERMIT NO. � Z�i � <br /> TheUndersi9ned,_,,,,+ _��y�:✓ � F� �� 1��1 � \� O�,tJ,1 p I� . <br /> Ne�eby applies for permission to�a�-1,h,�y..� -��(�Wv [l_)a,,,.t L,�,+c„n _ ���� �_ ' <br /> / ' J� V i.!/ f _ y, v ��..� <br /> At the following location__ , � � Ly,.�. .,� f�-� !0 ' <br /> G �—y�-� �N�Ma_J <br /> L" 4�.l f Ll �{s ��� M '1�J/ C _� ST 17Jh�/..� J( <br /> SKETCH �� <br /> (Work to be donc) <br /> <E,� �-����r:o <br /> .� <br /> i� <br /> i � <br /> i <br /> I <br /> � <br /> DRrvEWAv SECTION The undersiyned owner hereby agrees tu hold and <br /> {. NO SCA�E_ save harmless the Ciry ot Everett irom any and all <br /> I j claims for dama9es that rr�ay arise because ot installe� � <br /> I�� LIP tion and maintenance of Ihe improvement hereto <br /> � i 3��, 30„ I applied for and further agrees to remove same upon <br /> , r'��-���-- ---�----"-�- - ---'�'--'t notice from the City and to replace public properry <br /> damage ' eby. <br /> iM <br /> igna of pp icant <br /> �-- - -- - - - _ �----� !� 7 %71.c., . _ (�� <br /> � COPY OF THIS APPLICATION TO � Address r � � <br /> CE POS?EO ON JOBSITE. �� ��, <br /> .���!.LEN!7i�;<LRINGDEPT. 259�8Hii Telephone mI�zr <br /> �.��6 �OS <br /> ._: HOURS BFFOHC CO615 i fiUi::7ii';: Date <br /> (�' - .,'.? � - 7 7 <br /> CHECK LIST <br /> � Water Valve Fee ��*� 2�. '� /r�y/7T �; <br /> Dramaqe De t. Approvals <br /> Curb&Gutter Engineers�'r���-+�� <br /> Sidewalk <br /> Water <br /> Sveet <br /> —. Ccmmunications <br /> Inspector's Signature <br /> Traffic <br /> Planning_ <br /> �e — <br /> Remarks <br /> Note: Original to Customer � � <br /> , �°„YL° F�'� 10961 <br /> t co�Y to i�,:��cror Approved by <br /> � �►,. _ <br /> Date Approved <br /> � <br />