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- APPLICATION FOR RIGHT-OF•WAY USE PERMIT n <br />� ev�rNt y 1! I J� L <br />� <br />CI'"Y ENGINEERS `' F� <br />cVERETT, WASHINGTON PERMIT NO. ��` I✓�—!L' <br />� <br />r <br />The Undersigned <br />�� t_ 4 i�.� I.l,, . C-- ,� t:_<_;-; <br />Hereby applies for permission to �/�� ��r vC' T 23 �� <�N� �< �T� <br />�2I3! I / � iaJ�AA� <br />At the following location � 4 O 2 S�J N SC �' ,GA t�! i�. <br />(Work to be done) <br />pRC�t�o��D <br /><�,qRAC��- <br />rj� <br />M,u,� <br />/ <br />5�}07_ _,N <br />�'ATCil- � <br />Ei21/ I G c <br />IYJ �^�- -� <br />r -- z3 ��-- - <br />� � �I'� LIP � <br />'�30'+_ __—���_._i•30,'1 <br />COPY OF THIS APPLICATION TO� I <br />6E POSTED ON JOBSITE. I <br />�IAIL EfJGINEERING DEPT. 259-8f111 � <br />, ., i.iR:� ".I1�ORC (IONSTRUCTION�'� <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk � "= %'—` <br />—Y <br />v <br />��I <br />t <br />l� <br />EX. GUR13 � GUT'TEIZ <br />— SAN I TA IZ`i 5� U� ��= �':`?=r�. i'G <br />3ee ..9e�c-t.L <br />4v_• :c,f Gr�i,�/G^�%%.G R/�,wl� <br />�,O 8OS <br />4;3`t,r <br />( �a � <br />�-c�a�c j <br />� ( �O�/E : �WE2 �(�J!_ Tp <br />GLFAR AODITIDht Co� �^�•%��� <br />CAST �KON �— SGWEl2 P�k.N rT <br />(2�Q�►7. <br />1<4✓G� <br />���o s��„�,_ �,� <br />�¢���� <br />Remarks <br />Note: Original to Customer <br />1 Copy to File <br />1 Copy to Inspector <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everntt from any and all <br />\claims for damages that may arise because of installa� <br />tion and muintenancc of the improvement hereto <br />applied lor and furiher agrees to remove same upon <br />notice from the City and to replace publ�� �� ic ProPertY <br />dama6ed �ebY. , �, . � � <br />x.�': ���� 1 <br />� �� i <br />Si�naWic o App iCant . <br />� �'ir ;c' /%- a �"i.� ,>�ii. <br />'Address � � . /,, <br />�j / �J r <br />7e��p one mhber <br />X%_�c� � <br />ai� // So �� � ' !/-/ - 7 <br />Fee <br />{:,l �� I /j� Dept. Approvals <br />/' - . /� �_ ._ <br />Plann <br />1 I' t' O 2 Appraved by'ivv/ / — <br />/�f.4y <br />Datc Approved <br />��1�/ i_ 5 .. /��5'- <br />74 <br />