Laserfiche WebLink
APPLICATION FOR RIGHT-OF•WAY USE PERMIT <br />evcrett <br />e <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />J �� <br />The Undersigned � � �� - <br />Hereby app�ies for permission to L � <br />At the following location <br />� i� � <br />�Work to be done) <br />I <br />a ' <br />,� <br />� � <br />� J <br />iJZ';ll <br />l7' C UNC <br />Nu �u��� <br />ORIVEWAY SECTION <br />NO SCALE J <br />r--- ��' --- , <br />�f� LIP <br />I-30'�4-- --1 a'- ---I-'° -� <br />' Cfti'Y' UI� I{il`4 A{'PLIC.�I IiJi! IU <br />� i POSTED ON J06SITE �,. <br />"�,.L ENGINGERIiJGDEPT.259-£3311 � <br />. _ ��.Pti Cf`����RC-rr7f�!�:TRUOIIt;��, <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Side�v�lk <br />Inspector's SignaWre <br />D iral <br />-Gate -- . _---- --- -----. <br />Remarks <br />Notc: Original to Customer <br />iconvtoF�i� �.n��6 <br />1 CoPY lo Inspector <br />PERMIT <br />1�256 <br />,-; <br />P� . � ' <br />N,T� . �� �, .� ., � � ;� <br />/` � S� ' <br />UG: ✓ CI��." r�- � _ . <br />��./ l��e 'i �.l � 7 cu / e �- <br />n.: �jjd-� <br />__ � �i. 1 ''i � � S �F.✓ (,�7 <br />lli!;I �e�a '_illl. <br />'; - /'' �� <br />15� IN!- r_r/n 6 c; �/1"r' _i� <br />IJ� S'1��� �Ji!lk� <br />� OFlCI� Of �1,�� :1/�lli <br />The undersigned owner hereby agrees to hold and <br />save harmless die City of Evemtt from anY and all <br />claims for damages that may arise because of installa- <br />[ion and maintenance of the improvement hereto <br />applied for and further agmes to remove same upon <br />notice from the City and to repl. ce public property <br />damaged therebV. <br />1 ��.�- ,dt-G-,.-. �-,�...:�_-✓ <br />i �. <br />Signawre oi Applicant <br />/` (r �` -F l7% - <br />Address 9 ¢O �� <br />L �tnwce�. N/6.5�. <br />Telephone Numher <br />�9L lsSf� —778-�549 <br />Date <br />iy:. .� , ri . - _ <br />Fee <br />Dept. Approvals <br />Enginee/i,s — <br />Water \ G� � � � �' ^ <br />Slrect <br />Ccmmunications�� � '�'� N - � <br />Tra(fic <br />Planning � ���� <br />Approved by <br />Datc APP�ovcd <br />