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everett <br />� <br />CITY ENGINEERS <br />EVERETT.WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USC PERMIT <br />� 1��6 <br />PERMITNO. � �'- � �_ <br />The Undersigned ! � T � � �- /' % �it: _. / v — <br />Hereby applies tor permission to _���/�/ [� i� �+� ` A 2:� ,t�5���^ � Li�j ^! <br />At the following location % E �� 3' ���✓�" �' z��= � <br />(Work to be done) <br />.r <br />ORIVEW4Y SEP,TION <br />NO SCALE <br />f'----- --- . .. � <br />� j f� LIP-� <br />�,o� -�_�so� <br />' COP\' OF THIS APPLICATIUN TO I <br />I, �G POSTEU ON JOBSITE. ' <br />�i �Cn.f1CNGINf_ERINGDEP(.269-E3f>11 <br />'� ��i NOIJRS fiF �OHE CON;TRUCTIOFI <br />CHECK LIST i <br />Watar Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signaturc <br />Remarks <br />Nmc: Oiiginal to Cusf��im r <br />i conv to F�i� <br />1 CopV to Inspector <br />�.nK�s <br />' � I� i %'�r i7 - �� <br />0 <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and all . <br />claims for damages that may aris^ because of installa� <br />tion anA m intenance of the improvement hereto <br />applied for and furtiier agrees to ie ve s e upon �, <br />notice (r the City ar�l�to rep��ub�'�irc�rty <br />[i Y/1 >L � <br />S�- �c� <br />Uate " / / .'+'7 <br />�/? ''��� <br />Fee � <br />D/e�pt. A pro � s <br />7 <br />Engineers i� <br />Watcr <br />Stieet <br />Ccmmunications <br />Plann <br />Approved by <br />Datr. Appioved <br />0 <br />