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evcrcll <br />� <br />CITYENGINEERS <br />[VEflETT,WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />i0148 <br />PERMITNO. �� �� <br />The Undersigned �L /vIER STURU/VAN T <br />Hereby applies for pertnission tu CaNSTRUCT 2 Z'!-�S/'f /ALT D21 VE1/�f1Y <br />At the following I <br />(Work ro be done) <br />/ /i i <br />J�' <br />P� <br />30� <br />DRIVEWAY SECTION <br />NO S�ALE �J <br />� L 2 � —_ I <br />�" LIP <br />�-30 y_ _ __ � �_' _ _�,so'-i <br />' CUPI' Of- 7HIS .1f'PLII'.l1Tl��i� I U <br />I BC- POSTED ON JOBSITE. � <br />�, CALL FNGINEERING DEPT. 259�8811 II <br />�, "�i ! I� 7;;1� ; L'f=FOR6 CO^i51 RUCTIOF!, <br />LIST <br />Remarks <br />Note: Original to Customer <br />1 Copy to File <br />1 coPV to �nsnec,or <br />S�JUND A <br />-5� <br />VV AS(�J-IALT DRI �EWfA/ <br />EDGE QF EX/ST/NG <br />!'/�i//NG <br />C <br />� <br />NO S('JJL� <br />The undersigned owner hereby agrees to hold and <br />save harmless the Ciry of Everett irom any and all <br />claims for damages that may arise because of installa� <br />tion and maintenance of the improvement hereto <br />applied (or and turther agrees to remove same upon <br />notice from the Ciry and to replace public property <br />dama9ed there�y. <br />� `_ <br />.: r i., i . .r ,. -�G C <br />Signature of KFp icani <br />� <br />,� 'l <.1_- �,u�- ,/�f.c/ <br />AJdress <br />���,�•�•.�..r �'�v�,� 35"3 -., � �.;, <br />Telephone Number <br />Date �� o� � P� 3-a 7- 7S <br />Fee <br />�n,as <br />- � AUPro �ad by �: I ;: J � . <br />C� � � �i.C. � 2 , � C : � . ' `� ,' - <br />-! i . <br />� Date`ApUroved � � <br />