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cveretl <br />� <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />The Undersigned _ �f* '- <br />Hereby applies for permission to C <br />At the following <br />(Work to be done) <br />k' <br />Nc SCq�_� <br />APPLICATION FOR RIGHT•OF-WAY USE PERMIT 10210 <br />� <br />J <br />�,� <br />? <br />� <br />OFIVEWAV SECTION � <br />NO SCA�E <br />�---- /�� -- - ---{ <br />I" LIP <br />�so �__ �v • _ ._ _.4.ao � <br />�, .. <br />PERMIT NO. �� � �� <br />J <br />.:JPY OF THIS APPLICl4TIOiJ l0 '� <br />GC POSTED ON JOBSITE � <br />�'.�\lL ENGINEERING DEPT. 259�8811 . <br />7.: IIUIII25 !'.�1=�111C CONSTRUCTI(;,.���' <br />CHECK LIST <br />Water Valve <br />Drainage <br />Cuth & Gutter �'' <br />Sidewalk / <br />/ �;,`�//� <br />� ! , %i r' ;.l L <br />Inspecto'r's Signature <br />i <br />i - � <br />ate <br />.� � , <br />;' '� � '� j-, _ (/«?CC ,y'' <br />Remarks <br />Notc: Original to Customer � � 21 Q <br />1 CapV to File <br />i Cnpy to Inspector <br />%�I��N �� <br />�%Ilti <br />Yu:. <br />�wner hereby agrees to hold and <br />Ciry of Everett from any and all <br />claims lor damages that may arise because of installa� <br />tion and maintenance of the improvement hereto <br />applied tor and further a9rees to remove same upon <br />,� notice from the Ciry and to replace public properry <br />,�damaged thereby. `�� � /� <br />�c,'1 `� � I — �, ,,. ��.(l <br />Signature.ot ApP��cant <br />3' - 4';� � <br />',ri ' <br />�Address <br />�� <br />Telephone Number <br />Date <br />�..�G ' " -_aU - � <br />Fec <br />rt. APProvals <br />t/G�JI�LtiG.c� S = Z % %S <br />s-. �, ��� <br />�Yy� � <br />Appnrve, _��L � rrc-CLc� /..� �-r 7i <br />_ —� <br />v"/. <br />Caw F+ppioveJ � <br />