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� evcrcn <br />e <br />CITY ENGI�IEERS <br />EVERETT,WASHINGTON <br />The Undersigned `'����� 1 <br />Herehy apP�ies for permission to _ <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />1�6�i <br />PERMITN0. �L � - <br />�_.. . � � � n; > , :,r : , <br />At the tollowing location �L�L ` �1 !,c/'�.F � / ^l.��C <br />SKETCH <br />(Work to be done) <br />� <br />� <br />I <br />,::,s�+.,.,.•--: . <br />'�__. <br />Pa.�,ny <br />��t .a d <br />�—� o'' ' <br />�_ <br />5.q � <br />'`� G S la� �.�` ��'; <br />� <br />�,.<ned <br />G.v�a/ o.vr <br />� G..e��xt $od <br />4� <br />� r— <br />DRIVEWAY SECTION <br />NO SCALE — ��, �� <br />r ---� � � <br />.J �' <br />� I�� LIP � � <br />�°'�-- �— -- --i-30�-i <br />I COPY OF THIS.4PPLICATIUfd l0 <br />I BE POSTED ON J06SITE � <br />' ::i1LL ENGI�'EERING DEPT. 253�8871 I <br />i <br />i,; L1011RS F3EFORE CON5TRUCTIOi�J', <br />CHECK LIST <br />Watar Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspectoi's Signature <br />-b�v; - — - — - -- - <br />Hemarks <br />Notc Original to Customcr <br />,��,��t�F��� 10601 <br />1 Capy to Inspector <br />o '� <br />O <br />� �I <br />.V ! <br />� <br />� � `^'--�5 �; <br />_.-�--�.�_��� <br />/� `:unsNt L.:,,� <br />� The unde igned owner hereb ees to hold and <br />`�'"� �v savelia�m ess tie iry o ve F�n any anA all <br />claims for damages tha[ may a ise because of installa� <br />tion and maintenance of Ihe improvement hereto <br />applied for and furiher agrees m remove same upon <br />notice from the City and to replace public properry <br />dame ed ereby, <br />�'v a �. C� � �• .��� <br />�gnatur�Appl icant (1 <br />�_: U �- �I�y 1� O/Zd'� <br />Address <br />�..�r. -°��-�.969 <br />Telephone Number <br />'%— ?_' � �7!� <br />Date -. <br />�,s,�/ �i �'J j'i:l I i:I'i �7 �,� <br />Fce <br />Dept. Approvals <br />Engineers_� ' _� � � �� <br />/(� �(-' G"l--+ %' / "7 7 <br />4Vater <br />v '��, <br />StreeLf_�'.- ! � �i��>7 - <br />� �� <br />Communications _6�r��c.7i,�..�--1-.�_-.��-• 4.. � <br />Tra((ic <br />Plan ing <br />r , - � <br />. � ��,�_>> _-�,.� ,� � <br />Approved by <br />D�te Apprnvc,l <br />