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APPLICATION FOR RIGHT•OF-WAY USE PERMIT / <br /> e°�«" 10287 ��� l�i; ; <br /> e �'; � <br /> CITYENGINEERS � ��� <br /> EVERETT,WASHINGTON PERMIT NO.�� � <br /> The Undersigned C• G. TEEL — . <br /> Hereby applies for permission to CQNS%k'UGT Wf�TEP SERV ICE L//YE '��. <br /> �r_nnS� J-ILLEY _ <br /> At[he tollowing location 38-2-3- SM/TH <br /> '�, � � <br /> SKETCH <br /> (Work to be done) I <br /> NEW 1n/ATER <br /> .SE�V/CE [lNE (--�I <br /> � <br /> I <br /> !� 3H23 � <br /> i <br /> � NEW CATCHB�IS/N� 1 I <br /> � 3825 ' i <br /> � � <br /> � <br /> � EX/ST//VG G" C.r <br /> � WATE.� L/N,E � <br /> W <br /> � <br /> J <br /> � Na SCALL <br /> ORrvEwaY SEC710Y The undersigned owner hereby agrees to hold and <br /> NO SCaLE save harmless the Ciry of Everett from any and all <br /> -- ---� claims Tor damages that may arise because of installa� <br /> tion and maintenance nf the improvement hereto <br /> applied tor and furtlier agrees to remove same upon . <br /> � <br /> � i - �---- ------ � <br /> � notice from the City and to replace public property <br /> d� e6y. <br /> � : <br /> (1 , ^1� nSignature of Applic nt � <br /> �U� ,f{') �77 .C��03= �`'--=� <br /> � c'!'�+� ��F1NISnPPLICATI0NT0 � / �I�� Address�6 _syG � <br /> f,l_ �'OSTED ON JO�SITF�. � ��— <br /> � � � � Telephonc Number <br /> '�� C;�I L i�NG::�7GLRIDIG U6PT. 259-8811 ` -')i �/�� . <br /> - —-- -- - ri �l V / Date — <br /> . ., ;IC����,,; Br1�ORC CONSTRUCTION �.� � <br /> /�f/p _/���_ <br /> CHECK LIST n v Fee <br /> Watnr V81ve � ,r � -,��' �� Dept. Approvals <br /> Drainage /ry���j �U (i'li <br /> Curb&Gutter �/ n � Enginee . <br /> .� �� � �� O ��1n��_�� ' <br /> SiAewalk 1 " �i[� ^ 1 Water_� <br /> I �N '�n� Street�`'`"`''�r <br /> �:�..I�� Communica[jons.`-'� `�'• . . .•,�c". y-�y. 7�' <br /> Inspector'sSignaturc ,� I �� Traffic ��� � � ^ �---- - ��''" � <br /> li� � � <br /> ���� Planning- ��� . <br /> �-Date--- - — I <br /> Rem�iks <br /> No7r,: (lriyinal �o Customer �n��7 <br /> 1 Co;�y to File <br /> 1 Cnpy to Innpr.ctor Appioved by <br /> Date Approved <br />