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APPLICATION FOR RIGHT•OF-WAY USE PERMIT <br />evemt' <br />_� <br />CITY ENGINEERS <br />EVERETT,WASHINGTGN <br />The Undersic�ned � � ��� <br />Hereby applies for pormission to <br />At the following iocation �Jl�� s �Q U/T/.� �F <br />(Work to be done) <br />� <br />� <br />� <br />101.44 <br />PERMITNO. ��— � � <br />� <br />\ / / \ �/D' SEWE�P PASEMENT <br />60 � <br />DRIVEWAY SECTION <br />NO SCALE <br />r ,5--- - --; <br />� j I�� LIP <br />30" � 30 <br />i---�-�-- --- - /�— �{- ��-� <br />'co�vor-�Fiisa��ru�,a��iura�u � <br />BE POSTED ON.IOBSITE �, <br />CALL ENGWEERING DBPT. 259-8£111 I <br />'?a :icuc:, ::: I�oF;� r,nNs��nucri������, <br />� . . �, ! i <br />Insper.tor's Signature <br />` " �`„ f " '. � <br />—6ate <br />Remarks <br />Note: Original ro Cmmn�er <br />,�o,�Y�oF��� �.C�_�4 <br />1 Copy tu hisper.tcr <br />The undersipned owner hereby agrees to hold and <br />save harmless ihe Ciry of Evere[t from any and all <br />claims for damages that may arise because oi installa� <br />tion and maintenance o( the improvement hereto <br />applieA (or and furtlier a9rees [o iemove same upon <br />notiCe from the City and� replace public �roperry <br />oemsged thereby <br />_� � �9i )IS� >_�� <br />Signature of Applica�{. <br />✓ ?� 7 %� �" �=�lP,��Tl i//�, <br />Ad"dress ' <br />Telephonc umbe� r� <br />Date � �_� � /J,� <br />l�( �•d �-.9�— <br />Fee <br />��ro d bv j i � -, : <br />C.i� .cfJ� T.-,.fr[s�t LG :, �� . %�%S" <br />' Dat� 'Approve <br />