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everefl <br />e <br />CITV ENGINEERS <br />EVERETT,WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />10617 <br />PERMIT N0. '� « �' L� <br />The Undersigned _ ` <br />Hereby applies for permission ro � � �� I �� " [f � -/ �� / ' /��, i _ <br />� / <br />At thc following la:ation � � � �, �- _ %'�� ___ <br />� <br />(Work to be done) <br />�' <br />/�i " <br />� <br />��� <br />h� r 'J c,� ic <br />��$:'.�h'��1� <br />% �{. Ll L' `r <br />�__ ��la <br />�—__..:j1 � ' I' � <br />'. �'-s L<�c�ti�.,,� \ i � <br />i <br />� � t,� :U� � � <br />�' <br />`? }_ �' � .\ <br />I _ �',� ` <br />.. <br />� '�' " �,,�� ' i <br />�J f�r Vr <br />� � �1 ' �.. <br />- �\ I � <br />LCt <br />.N <br />. — �.___ ,�.._"__� <br />_'_______'_. �. /_" .__'.____ <br />DRIVEWAY $ECTION <br />NO SCALE <br />�_ — _ _ � <br />I" LIP �l <br />4•_3_Q•.Y —_ �•30 �1 <br />ICOPY OF THIS APPLICATION TO i <br />� [3E POSTED ON JORSITE. <br />I CA�L F.NGIN[ERING DEPT. 259�t3£311 I <br />�74 HOUFS [3f-fOflE CONSTRUClIOi��' <br />CHECK LIST <br />Water Valve <br />Drainage <br />Cur6 & Gutter <br />Sidewalk <br />Inspector's Signature <br />�atc <br />Remarks <br />Note: Original to Custonier <br />, �o�Y to F,�� � p r 1 7 <br />1 CopY to Inspecmr <br />���, <br /><' - i <br />.'�..� ... _._. _. _ <br />The undersigned owner here; , agrees to hold and <br />save harmless the City of Everett from any and all <br />claims tor damages Ihat may arise because ot installa� <br />tion and maintenance of the improvement hereto <br />applied for and further agrees to remove same upon <br />notice from the City and to replace public properry <br />damaged ihereby. . <br />� <br />'1-'.. ;/ u � '.. r" f.c: ��.�,i.Cl, il'�� �_ <br />Signature of Appli�ant <br />�- �'�1 l � . - _ i,:-�n���� ,_ <br />Address <br />4�5" �I � � <br />Telephone Number <br />' 7 4� <br />Date <br />Dept. Approvals <br />Water{-! .:5',._ t,n� <<. .i..�_ i�c <br />� <br />Cemmunications <br />.Plem�iny �. . <br />� - _ �'J C T�.i � _ ,������, iiL <br />Approved by <br />Date Approved <br />