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<br /> APPLICATION FOR RIGHT-OF-WAY USE PERMIT � �
<br /> everett � 1�3 8'� �/��� �
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<br /> CITY ENGINEERS
<br /> EVERETT,WASHINGTON PERMITNO. ' �-' �
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<br /> He!eby applies for permission to �
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<br /> � At'the following loca[ion =i i �1 - i / ' -�� •L .
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<br /> DRIVEWAY SECTION The undersigned owner hereby agrees to hold and '.
<br /> ' ' NO SCA�E save harmless the City of Everett from any and all '�.
<br /> �---- ��C ' ------ - � claims tor damages that may arise because of installa� �
<br /> tion and maintenance of the improvement hereto
<br /> � �� ��P� J +/ aGPlied for and further agrees to remove same upon ��
<br /> 30,� /" J ��
<br /> 30 � notice from t Cit and to replace public property ,
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<br /> , . *� Sign ure of A piicant �-' �
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<br /> COPY Of- TH IS l�PPLICATION �i0 I Address 'ie�-��5i
<br /> F3E POST[D ON J06SITE. ��� ''-�' ��G' ,
<br /> � Telephone Nu ber �
<br /> CALL FIJGINEERING DEPT. 259�8671 I,, .��j .��7L ,
<br /> � 7.4 fiOURS C�FFORf_ Ci1f�1STRl1CTl0�!�' Date /� /e� I
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<br /> ' CHECK LIST Fee � I
<br /> Water Valve s , , .. D t. A pro I5
<br /> �, Draina9e ' �-�S.' . , � �I
<br /> Curb&Gutter Engineer � �
<br /> Sidewalk Water r scl+�C;�
<br /> � Street /t�,....�
<br /> `'���_ ,�.�._ ����'"� Communicati s
<br /> Insp tor's Signawre Treffic ��`" " � �` �
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<br /> Remarlcs
<br /> Note: Original to Customer -y---
<br /> i Copy to File 1��8 3 � '�
<br /> 1 Copy to Inspector Approved by 3
<br /> Da[e pproved
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