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ev� <br />CITY ENGINEERS <br />EVERETT, WASFIINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />11025 <br />PERMITNO. �7/3� J <br />The Undersigned /�%%' L GL� �' :i I� %"G;:' i <br />HerebY applies for permission to (Ri�<:'F, � �-7' �-i y;'„i�.� n.,� ,%.7{ n' �7 :.� ��,✓ : � ��- ;-��. �: �J �i.-� Iir/ ,�7?'�v�'.� <br />/',�.:r- .`✓ .ai'�n'. y� �O�rF:�� �O�i7i.�/J �_` `!./i f .✓��:ID JL. <br />�, � � <br />At the foliowing location �f J 7 �/%�0 0 f�� AC r� <br />�Work to be doncl <br />G�'. :97%,ic.Nc � <br />��oit . � oj'c7' v�v^�,_:Z �r <br />i/y�� .-1JJr�G��Ji �i: . .T <br />�nA�NTi�,�,��,c T�,>' !`•.o v.� ��'rv�� CiiN'V4 <br />C�,'i�a: i',�t SiFNS Y �C iT: �-,t. <br />DRIVEWAY SECTION <br />NO SCALE �,J <br />I�___— —__.__ I <br />I T <br />� I" LIP / � <br />L30�_. _—_ _ __. I 30" I <br />i- �'1' '1 <br />COPY OF THIS APPLICATION TO ' <br />�E POSTED ON JCBSITE. �� <br />C�LL �-iJGifVF[Pif:�l DEpT. 259�8811 �i <br />' "'.� itUUFS IiEFC1fiE C:UNSTRUCTION; <br />i _ <br />CH[CK UST <br />Water Valve <br />Drainage <br />Curb & Gutter , <br />Sidewalk � <br />Signaturc <br />Remarks <br />The undersigned owner hereby agrees to hold and <br />save harmless the City oi Everett from any and all <br />claims for damiages that may arise because of installa� <br />tion and maintenance of the improvement hereto <br />applied for and further ayrees to remove same upon <br />notice from the City and to replace public procarty <br />dam d t�reLy. � 1 <br />��Z/_�_y�"_- y=�l�G� <br />Sig ature oi ApplicantG �. <br />�J ., � CC/C� <br />F-�fi �'-�.1' <br />Address v� �- �. � <br />:'-_r.7! - 1 � 0 9 �.� oJ_sx'-/ ; �-2 <br />Telephone Number <br />�1- Z �-''7"7 <br />Date <br />�; � <br />N�� /'�„-, <br />Fee — <br />LDept. pro� als <br />Engineers L �/ e � �rcc�' <br />Strcet��" � 4�' <br />Q <br />Note: Original to Custcmer <br />1 CopY to Pile 110 2 5 <br />1 Copy to InsUector Approved 6y ' <br />Date Approved <br />