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evcrett <br />� <br />CITY Ef�GIN[ERS <br />F.VERETT. WASHIhGTON <br />The Under,igned _13� <br />Here6y applies for permissii <br />At the following location_ <br />SKETCH <br />(Work to be done) �i <br />1 <br />,. �,� .�- s'���, <br />qpPLICATION FUR RIGHT-OF-WAY USE PERMIT <br />tr / <br />1 <br />to <br />� l - --�---�- ; . <br />,1,'' . <br />ORI\'EWAY SECTION <br />NO SCP.LE _ � <br />L.— — --- <br />I <br />T �I�� LIP � <br />i � I <br />�30�.,_.._____._ ____—.L30+1 <br />- i <br />COPY Of- THIS �1PPLICAI�IOF! i0 <br />BE POSTED ON JOUSITE. , <br />CALL ENGINEERING DEPT. 259�R81 I <br />.: ill)IJ9S 1'.�.R?RC CC�N';TRU('TIi7': <br />CHFCK LIST <br />Wator Valve <br />Drainage <br />Curh & Gutter <br />Sidewalk , . <br />Inspector'S Signawre <br />, <br />_�.. ._. <br />� . ` � , �,,, <br />Note: Onr�inal to Customcr � O R�� <br />i CopY to Filc <br />1 CoPy to InsPectoi <br />PERMIT <br />10878 <br />The undersigned owner hereby agrees to hold and <br />save h� rmless thc Ciry of Everett fro any aud all <br />claims �or damar,es that may arise ber use of installa� <br />tion �nJ maintenance of the improvement hereto <br />applied for and iurther agrees to remove zame upon <br />notice Irom' the Ciry and to rep�ace pu6lic property <br />demaged.�tl�ereby. <br />i <br />SignaWre of Applicant <br />Address <br />Tclephone Numbor <br />I: j _ <br />Date � ._ �' <br />fCe <br />Dept. Approvals <br />Engineers <br />Ccmmun <br />Approved by <br />U, le Appiovrd <br />