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evcret' <br />. � <br />CITY ENGINEERS <br />EVERETT, N/ASHINGTON <br />The Undersigned ' �' � . <br />Hereby applies for permission to <br />At thr. following location <br />{Work to be done) <br />APPLICATION FOR RIGFfT-OF•WAY USE PERMII <br />10877 <br />PERMIT N0. <br />; ,: . <br />�. <br />� _ �– , <br />. .. � -- � . ` i <br />,��z sT .S'icN <br />ORIVEWP.� SECTION <br />NO SC4LE <br />r__ -- ---� <br />1 3�j I�� I IP %� <br />� —_— . _ _ _—•1•30 �{ <br />r � <br />- I <br />cur�Y or rriis;����ucnnon ro <br />BE POSTLD ON JOBSITF. <br />I CAIL EMGME[RING DEPT. 25P�f3fi� 1 I <br />':� IIOURS fiEFpF7ECO�:�TI',uCTION <br />CHECK UST <br />Water Valve <br />Oraina9e <br />Curb & Gutter <br />Sidewalk � . � <br />Inspector's Signa[ure <br />�atc—'------- <br />Reinarks <br />Nufi: Oiipinal to Cu;tomer <br />iCoPY[of•ile a.��77 <br />1 CopV to Inspcctor <br />� <br />Thc undersi9ned owner hereby ayrees m hold and <br />save harmless the Ciry of Eeerett from any and all <br />claims for damages that may arise because of installa� <br />tion and maintenance of U�e improvement hereto <br />applied tor and further agrees to remove same upon <br />notice froiP the City and to replace puL:ic property <br />damaged tliEreby. - " . - <br />� i � -" ' � �y �� i <br />Signature of A�IIcaoL� <br />;:,J <br />AV���SS �.. --- -- .; <br />Telephone Numpet <br />Date��.� � <br />Dept. Approva'ts <br />;� <br />Engineers - <br />Communications <br />Planning <br />A�proved by <br />Datc Apnroved <br />�' <br />