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APPLICATION FOR RIGHT•OF-WAY USE PERMiT <br /> . . everett 10 7 5 7 <br /> e <br /> CI?Y ENGINEERS <br /> EVERETT,WASHINGTON PERMIT N0,_ � L' r�� <br /> The Undersigned '! /r'«-��U 1 : Fr:�.�✓ �'f l�'K l,�� / <br /> � <br /> � Hereby cpplies for permission to P�,� i / t F/��c H Si(�E � rN �'� T`/ �rl e'�li d c ST��1'- - n-� 7i � �' <br /> 3 ,nM� � <br /> . 'iTJAIi S � /.�i7 Dowrv y SnuT4L T/!c'S �uAt'i7� YAr;rc�i.t: �o',(i0 nl,y�,'��'Ef4iNir✓i N�iJu- i <br /> At the following location N iN_ ( or.'�y."� /S'�` J W% r'�to -n' �'�ssi��. <br /> � 5'�.�' i.%� ' ,�•�� , <br /> �� SKETCH �. <br /> � (Work to be done) �� <br /> � <br /> S li� l�i i A�Nr V � <br /> ' <br /> I � <br /> � <br /> I <br /> i <br /> i <br /> i <br /> i <br /> ', DRrvEwAY SEC7i0N The undersigned owner hereby agrees to hold and � <br /> NO SCALE save harmless the City of Everett irom any and all ' <br /> � r-- �-�---- - � claims tor damages that may arise because of installa� � <br /> �I" LIP J� tion and maintenancc of the improvement hereto I <br /> applied for and turther agrees to remove same upon � <br /> �30�___ . I 30"�J notice from the City and to replace public property �I <br /> --� <br /> � damage i , y, i <br /> � I <br /> � Signatur Applicant � <br /> � � - <br /> L.� <br /> ' I COPY OF THIS APPLICATION TO ' AAdress � <br /> L',[ POSTED ON J06SITE. o7'iJ-n si(/ <br /> C�LL CNGIr�EERING DEPT. 259�IIR17 Telephone Number i <br /> 3-aH- 7' <br /> � 2•i I10URS GEFORG CONSTRUCTIOIV�� Date � <br /> N-- �-o� I <br /> CHECK LIST Fee � <br /> ' Water Valve Dept. AppreValS <br /> Drainage f �, <br /> Lurb&Gutrer � Engineers - ��'�- '� ' <br /> SiAewalk Water ���-ti ✓ r , ,( . <br /> �- <br /> Street <br /> Communications <br /> Inspector's Signaturc <br /> Traf(ic <br /> Planning__� <br /> .+ <br /> at-b e — ' r�...n ����� . <br /> �7emarks <br /> No�c: Original to Customer -- . <br /> � convcoFi�r �0757 �. <br /> 1 Copy to Inspector Approved 6y � <br /> Datc ApP��ved — <br />