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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />everelt 10 6 3 4 <br />� r <br />CITY ENGINEERS � <br />EVERETT, WASHINGTON PERMIT �10, n—.� �U <br />The Undersigned �_C)1�l✓i ��L �� � � �"��r <br />Hereby applies for permission to i�.,y s�.�.,� � 2� � �� n!� a��� i4 �. �.; <br />At [he following location <br />(Work to be done) <br />�,�•1 ci �, t. S �J <br />,, o.o a rca:r..�� .,� �t :t��-'� <br />i,f r�,C c,ry �� ���..� <br />�� I l �-. = %�--+ - — <br />�. DRIVEWAY 3ECTION <br />NO SCALE <br />I L.— � <br />I <br />I I" UP <br />., �0�_..—_ _--._..��.3—'1 <br />i <br />�. COPYQFTHISAPPLICATIONI�O ��� <br />. BE POSTED ON JOBSITE. i <br />' CALL ENGINEERIfdG DEPT. 259-8811 I <br />� <br />� 24 HOURS BEFORE CO�ST�UCTIGN �. <br />— -- --- ___ _ , <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewa�k <br />Inspector's Signature <br />� � <br />Remarks <br />Note: Original to Customer <br />7 Copy to File 1_ n�� 4 <br />i Copy to Inspector <br />� <br />r <br />The undersigned owner herehy agrees to hold and <br />save harmless the City of Everett from any and all <br />claims for damages that may arise because of installa- <br />tian 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 property <br />• , dam�e�shereby. ' <br />Signature o pplica t � • <br />l� l�i �l."� %��n �.:' CL Y l/C- ii r: c <br />Address <br />Telephone Number <br />�/ �' �' L'�G <br />Date <br />,��,��/�7-T= <br />Fee � <br />, '' Dept. Approvals' <br />_ . <' �7� ,7r" _ �% . <br />iJ...T % <br />_ �'s}«--.�"_.-.-.` - <br />i <br />Communications <br />Planning <br />p i� �--� <br />7a r� - [ ":cr .i �l � fan � l' % l <br />Approved by <br />Date Approved <br />