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; <br />� <br />cveren <br />� <br />CITY ENGIP�EERS <br />EVER[TT.WASHINGTON <br />APPLICATION FOR RIGHT-OFWAY USE PERMIT <br />J_1025 <br />PLRMIT N0._� ��:' -+__ <br />,��,>'�, .-r..�J �- ,<f,,� .,_. <br />The Undersi4 �ed _ <br />Herebl'�VPliesforpermissionto',:.� �.�>�.,cr� ,i ft.��',�•r�'o��. ,�,�• --.�-.. . . � ..�-.. ..� <br />t'. . . ,i r�i't:!�C;_t_�.i��� 6°,��' �n!'F'ir� Pi' _i-�f_LCY'.`-'.._1^ j�� "—" <br />At the tollowing <br />(Work to Iw donel <br />c:f � �?-� . , �..' <br />1�'°�`r' _ . �,. . : ,.,. <br />,; <br />qr�� �%��J��L.,-�lV^' j7 u; .. "� .. ..', 'l,. ,r <br />;.,r/]ir. -r1,.�,.iG 7i•.r' �... .-. . i'iv. , „ <br />;?�: i �; -���.� L .'>/�%/b'.:' { ,( ��'"t��. . <br />� ����� �P.Cd%�%%�'�L'%i� �//� F� tS/� IC� �7'ff7'l/?�%lJ7�l� 1f /� <br />/ � <br />6� de.'.,d C�..t !�f �.J�/f i�" f^va�.re+U��,-� Zliiiral�v�f- <br />�.���, �� . <br />eGave �Oule� <br />O F `BO7� e - <br />�ol� �7' �So��7"%c.. J'_7j Got��F- ou1`d:�e <br />�f7'le-�e Fe��' �f' �ig �✓ . <br />�/sa �i�i�/6e ,OG�D7' ���.a�� . S/�oo/�,� 9?a�if7r{� <br />�t�J i�'/A�/ !%.�ve SerJ+'r�E ��...7`c..1-e ..c-..I� _ <br />l � �°s <br />� <br />OFIVEWAY SECTiON <br />NO SCALE <br />I�__—__— __—_.'_ _� <br />I —7� <br />I" LIP / 1 <br />� 3O'� __-i— . _ _�.3Q I <br />..-'.--..__--- ••� <br />j COPY OF THIS APPUCATION TO <br />I BE POSTED ON JOB;ITE. <br />j CALI ENGINEERIIJG DEPT.259�8�11 <br />Ii24 HOURS BEPORE CONSTRUCTION <br />CHECK LIST <br />water valve <br />Drainage <br />Curb & Gutter � <br />Sidewalk <br />Inspector's Signature <br />Note: Original to Customer <br />1 Copy to File 110 2 5 <br />1 Copy to Inspector <br />The undcrsigned owner hereby agrecs to holA and <br />savc harmles: ihe Ciry of Evcrett from any and all <br />claims (or damages that may arise because of installa� <br />tmn and mainrenance of the improvement hereto <br />appiied for and furthcr ayrecs to remove same upon <br />notice irom �he Ciry and to replace public properry <br />Aam 9ed thereby. .. ._ <br />�--- <br />�% �•.� � �� �� _i-<.(�.;.-�.. <br />�'-�— -- -1.s.� <br />Si�'nawrc of ApU�icant <br />.:i� 'Y CC, 4�`C..�t.i r.7� . <br />Address ' `' "'�' <br />� i 1�1`J :' � ' ^"�: <br />.. ` / - <br />Telephone Number <br />: ) .>�-�,�i -- <br />Date <br />n' , F , <br />Dept. P�pprovals <br />�-� i� <br />Gngineers ,� ' L �"=- ' <br />Strer.t <br />Communications <br />Traf fic <br />Approved by <br />Datc ApP���eJ <br />