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everett ' <br />� <br />CITY ENGINEERS <br />EVERETT,WqSHINGTON <br />APPLICATION FOR RIGHT•OF-WAY USE PERMIT <br />PERMIT <br />10104 <br />�4 - 2�� <br />The Undersigned �EN -/�"�UN -�7 <br />Hereby applies for permission to CONST2UC T Z�' CDNC�'ETE D/?/ I/EI/✓�1Y <br />/-1ND L/-7NDSGFIPE aN C/TY '-G-W <br />At the following location 4-j0 S �U C/�/_/z � U�. <br />�ncii.n / -� ��//VG <br />(Work to be done� �EX�S�'' '� <br />��/�,r_ r�<7,*,`'.:.�i��f <br />�EXi��n.vG M.N,.. <br />� ALLE y 5,_ <br />- --, - <br />ii�� <br />�i4 � - w 430.5 <br />� �, <br />�� s, wAur <br />I�' L D <br />�It �c''�Pi <br />�(� <br />�I•; <br />�G. -�NEW C,�j <br />T <br />s ,� ,s S <br />� ----NEW �RrVeW�7y <br />DRrvEWAV SECTION <br />NO SCA�E <br />�-- -- 25'- -- "1 <br />�tl" LIP� <br />4.30�—._— ��� _—�f.30.,� <br />-i <br />Ti�iN�N(o G/AL ( <br />lEW Ca�vG <br />� �oEw,aG IS <br />li.:j ,� '1 <br />-�C ���� u»Icr S�rv�(es �'brC „� Cn�s1t�.���u� �i� C��V. � <br />� - - - -- -- � _ "'I <br />cOPY OF THIS APPLIGATION TO <br />RL POSTED ON J06SITE. <br />��.%U.I LfvGIF.!_ERItJGDEPT.259$fl11 <br />:'�1 HiiL;i��; I;I.i�ONL LGNSTRUCTIONI <br />CHECK LIST <br />Water Valve <br />Drainage <br />Cwb & Gutter <br />Sidewalk <br />/ , <br />.' <br />�' . ,��,,� � . <br />Inspector's Signature <br />— r �_ <br />Remarks <br />Notc: Original to Customer <br />i conv io F�i� <br />1 Copy �o Inspecror <br />e <br />rxisr <br />M, l�F, <br />C.B <br />�crAiNiN6 <br />�lJAGL <br />The undersigned owner hereby aymes ro hold and <br />save harmless ihe City of Everett from any and all <br />claims for damages ihat may arise because of installa� <br />tion and maintenance o( the improvement hereto <br />applied for and further agrees to remove same upon <br />n f iom the City and to re lace public property <br />ed theieby. � <br />✓Lu-�- v �-' �G CGt��. <br />ignaWre of Applicant � vv , a� u/���rS <br />l r�7 ��'� /ncf/ Lvn.✓ R�D� <br />Address <br />x= �1 m_ � i.�w-Sri —ij? i v �/ <br />Telephone Number iy q Z_ 3 g 9 U <br />Date <br />Qe�D /7,So ��Q /-/S->S <br />ra�_2/o-��` Fee <br />'7'� • �' <br />� <br />i �1 n �� � ApProved by � <br />Datc�lpproved -. �,+.i �5� <br />V <br />f� <br />