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APPLiCATION FOR RIGHT-OF•WAY USE PERMIT <br /> �°� 10300 <br /> CITY ENGINEERS ` " <br /> EVERETT,WASHINGTON PERMI', IVO._ '�� ' %�� "" <br /> The Undersigned k�1�1 =- '� �1=�� T/i��� � �� �� ���f�- �s <br /> Hereby applies tor pormission to � ��t / � �� T ,=1 � �? � �%(±l� <br /> At the following location J� �U ' �/ �L �� ��� �� U L �< ��. , <br /> LuT 13 _ <br /> SKETCH � <br /> (Work to be done� / �� <br /> i <br /> �� � <br /> �'�L>E: �71= �l( ISTING RORU <br /> /2 <br /> / / � <br /> � ' <br /> / �\� � //� <br /> i�' / : <br /> � <br /> � � <br /> // �' �- . <br /> / / ' <br /> i <br /> �/ / %� i �k� � .. <br /> �� _"� <br /> � ;�� �!f�AJ t_ ,�' 'L �'� / �/ <br /> ,�:�\ <br /> N�iK. i��� cu�v�r�r '`� ;' `����'�� <br /> . ; <br /> %� G�U SLraL� <br /> i ; <br /> �' <br /> �. <br /> � ORIVEwAv SEC710N ` The undersigned owner hereby agrees to ho�d and <br /> NO SCALE save harmless the City of Evcrett irom any and all <br /> �_ � � <br /> �I claims for damages ihat may arise because of ins[alla� <br /> T— �—, �P �, tion and maintenance of the imUrovement hereto <br /> I �--i=� applied for and further agrees to remove same upon <br /> �30 I �� I 3� notice (rom the City and to replace pu6lic property ' <br /> --"t� �t"--� <br /> damaged thereby� , . <br /> i l�� <br /> Signa ure o(ApPlican /-� <br /> _ . _. _ . i�'7 5 i v;�< LG�-./• <br /> GOPY UF 1"HI; APPLIC:�710N �i�0 ,'� Address ' <br /> BE POSTE� ON JOBSITE. � '" - � 'L v 6 <br /> � Telephone Number � <br /> , Cn l GNGINEERING DEPT. 269�IIt?t t � i <br /> „ <br /> s a�r-aai- r.or ,��;�rc� i��r.i' 1) 'Ul✓ L� Y' L J l� •��. oece � <br /> � � - �� - 75 ��� .-,� ��,_ io <br /> CHECK LIST Fce <br /> Wamr va�ve Dept. Approvals <br /> Urainage En meer F �-''�� /�� //' `�o-7-7S <br /> Curb&Gutter 9� ` �! <br /> Sidewalk Water �. J9iiat-._ ��-/ � 7� <br /> Strnet .<,���" . ,� � <br /> ' l% 5..�-.cU - �t'- R :'�- <br /> ___����tit. . _ Communication ' <br /> Inspe rsSignature �� �� � � ` Traffic • `���`� -�- � �� � :' - <br /> _, / . Pl�nnin <br /> � ' :� � � /0 <br /> � � � ' `,• <br /> �ace <br /> Pemarl<s <br /> Notc Original to Customer <br /> 1 CoPy to f-ilc 1 n �� � /� /� - . <br /> 1 Cupy to Inzpecim A���� � �� J' �(�� - �'� �/�- ���- <br /> .._ .L Y"�,♦ '_/Y(��Irp��i�L�� / �� <br /> / �� <br /> o;,�• n���o��d <br />