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APPLICA'fION FOR RiGHT•OF-WAY USE PERMIT
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<br /> CITY ENGINEERS PERMIT NO.� ��
<br /> FVERETT,WASHINGTON
<br /> The Undeisigned N� r ��`/ ���1� ! r r
<br /> Hereby applies for permission m �' � � , ' .+ , i ' �^ -�a' �' � rE »c v e� c!�
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<br /> . DRrvEwAY SECTION - �I '-' ` The undersigned owner hereby agiees to hold and
<br /> NO SCALE � '�'` 'I• ' save harmless the City of Everet[irom any and all
<br /> � _ � ---- -�-� claims for damages that may arise because of installa-
<br /> � tion and maintenance of the improvement hereto
<br /> i' UP applied for and (urther agrees to remove same upon
<br /> 30'�j„_____ -_ ----�--.4.3� r�otice trom the City and to replace public property
<br /> ' damaged thereby. .
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<br /> _!,�L��Qe, 'f71 /;'/ M..t_-/
<br /> Signature ot pplicant
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<br /> � �� � CQPY OF- THISAPPLICnIfON lU Addr s
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<br /> � - ;:E POSTED ON JOBSITE. ',
<br /> Telep one Number
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<br /> �I Ilu'.��;-.:3 �.'.,.��OREU3�,dTItUC, lO,-l� Dete
<br /> �CHECK LIST Fee
<br /> Water Valve � p r YalS
<br /> Drainage �"��
<br /> Curb&Gutter
<br /> Engineer_ _ S
<br /> Sidewalk Water �� �� � � .��.1,.'
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<br /> � ', ' Cemmunications .�� i. 3� �� � ���
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<br /> Note: Uriginal to Customer _ _ _ _
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<br /> � 7 Copy to File �. ��.� � � �'"'� qpproved� � /i
<br /> 1 CopY to In:pector ,__ ,� , i ,' �/^=/�/
<br /> UaCc Approved �
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