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APPLICATION FOR RIGHT•OF-WAY USE PERMIT <br /> everetl , �O C�8 5 <br /> � <br /> CITYENGINEERS � � ' <br /> EVERETT,WASHINGTON PERMIT NO. ��-'%/ <br /> The Undersigned � ' � ' � � �� — <br /> . , , i� � .. �i! <br /> Hereby applies for permission to�r� —�f�--- <br /> At the following location_�„� -� � " _ <br /> /. ' <br /> SKETCH <br /> (Work to be donel <br /> � :� � � � � . . - : <br /> DRIVEwAv SEC7i0N The undersign�d owner hereby agrees to hold and <br /> NO SCaLE save harmless the CitY of Everen from any and a�l � <br /> - �- � —� claims for dama9e;that may arise because o( installa� <br /> � � tion and maintenance of the improvement hereto <br /> +I" LIP applied for anJ further agrees to remove same upon <br /> I„3o'�__.—_ __—.�.30��� notice irom thr. City and to replace public property <br /> ' � ��amagedthereby � i '•. <br /> )� ��, . / i /,. , i �� � <br /> i ,i -'�J--4'1�L..:i1 . _:,i . .. � ���� <br /> � t�Jnature oPAp hca f <br /> 1� : �� � <br /> /� � . / ,.. //�> ' <br /> �, COPY OP �HIS APPI_ICATION TO Addre s '�. :�� � <br /> �I E3E POSTf=U ON JOBSITE. '�, '. ; �"� � i� . <br /> Telephone Nu�9ber . <br /> �� C�\LL GNGINEERING DEPT. 259-3611 i �'% %-7 / %7 _ � <br /> �I 2d HOURS RFf-ORF CONSTRUCTIOt�! <br /> Date � <br /> 4-� i <br /> CHECK LIST Fee ,"-M � ' ' � � �— <br /> Water Valve Dept. Appritvals <br /> Drainage <br /> Curb&Gutter Engineers �-_ <br /> Sidewalk� Water <br /> Street <br /> Ccmmunications <br /> Inspector'sSignature Trailic __ <br /> Planning <br /> -6ate <br /> Remarks <br /> fJote: Oriyinal to Custom�� <br /> 7 Copy m Pile �O a� 5 <br /> 1 Copy to Inspectoi Approvecl bY <br /> Date ApP��oved <br />