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APPLICATION FOR RIGliT•OF-WAY USE PERMIT <br /> � ���.�n 10 5�7 <br /> � e <br /> CITY ENGINEERS � ' •"� ,; -,7 �� <br /> EVERETT,WASHINGTON PERMIT N0._ . <br /> The Undersigned �:� ' : iL� . ' _'--1.i � � � ��• � ' . — ' �'� <br /> Hereby apUlies for permission to � i " * � � ' � � � '� <br /> At the following location °/ ' ��- �-� ' ��� —i�._�— - <br /> SKETCH <br /> . (Work to be dore) <br /> � _ t , . . . . . _ �? <br /> . DRIVEwAY SECTION The undersigned owner hereby agrces ro hold and <br /> NO SCaLE save harmless the City of Everett irom any and all <br /> I.--- —�-- ---� claims for damages that may arise because of installa� <br /> I <br /> ,1,� ` P �,� tion and maintenance of the improvement herero � <br /> applied for and further agrees to remove same upon <br /> �30'�____ ___._-__�.3G��..� notice from e City and to replace pubiic prop^rty <br /> . damaged�t er by. � �� � <br /> �� <br /> Signamr¢of pp icant <br /> � (��,. !�. , �� <br /> COPY Of-�THIS APPI_ICATION 7U ' Address � � <br /> J <br /> � 6[ POSTEC ON JOBSITE. Telephone Number <br /> ' CAI_L [NGIP:f_6RING [1LPT. 25&HY,11 � <br /> �, 74 IfOUHS B1=P�.)R[ CONSTRUCTI�:)N' Dete , , �., <br /> CHECK LIST Fee " <br /> lVater Valve Dept. Approvals -�. , <br /> Drainage <br /> Curb&Gutter Engineers __ — <br /> i <br /> Sidewalk Water - — <br /> Street __ <br /> Communications __ <br /> Inspector's Signature Traific . <br /> Planning <br /> ate <br /> Remarks <br /> Note: Original to Customer <br /> , �o„Y �oF,�� 10977 — _ <br /> 1 Copy to hispector Approved by <br /> Da[e Approved <br />