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everetl <br />� <br />CITY ENGINEERS <br />EVERETT, WASH1PdGTC•�J <br />The Undersi9neJ _Fi t% �/� <br />Hereby applies for pertnis�n to <br />A[ the following location '� <br />SKETCH — <br />(Work to be done) <br />APPLICATION FOR RIGHT•OF•WAY USE PERMIT <br />OR'VEW9Y SECTION <br />NO SCALE <br />�_—_— ---___ ---� <br />��I'� LIP <br />i '°_:4- - ��-- --- --i-3O �-I <br />COPY Of- TH IS APP! ICATION TO �� <br />EE POSTED O� JOBSITE. <br />� C�LL ENGINEERING DEPT. 259-8R11 <br />24 I10URS pEFORE CONSTRUCi�ION � <br />�__ <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter �✓�-� �� �' . <br />Sidewalk _ � <br />Inspector's Siynature <br />Remarks <br />Note: Original co Customer <br />1 Copy to File � n�� O <br />7 Copy to Inspector <br />,ri' �.... . <br />rj� � /-�'�%J�G/?•; � <br />10?90 <br />PERMITNO. .� '� i�-�U <br />� _ - - �. (.. `.� , <br />� <br />v�. �� �'' <br />/r y � � <br />n <br />,J(.,r.v ��- i <br />�vt ' �,J� ��' <br />o ��'1 i, <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 arise because of installa- <br />tion and maintenance of the improvement hereto <br />applied for and further agrees to remove same upon <br />notice from the City and to replace public property <br />da thereby. - <br />igna e of A�ficant � <br />Address ' <br />2 � ,�' -� <br />�<'3-oiL,? <br />Tclephone Numbc� <br />y� ,t/ L� <br />Date i <br />� ` �'� %�� <br />Fee <br />� Dept. Approvals <br />� � <br />����-�'Jj �'J l����. EngineefS�L'�l��/ <br />Water �.� � ��" � <br />� ' . •��;=..: <br />Street - �` � � � 1/y � • <br />Communicatinns <br />Planning <br />�i _4 /J .: i � D - S (' �r � f i % ��-sl. � <br />�--`�:`--� �J" <br />Approved by <br />Date AUProved �-- --- <br />