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evcrett <br />� <br />CITY ENGINEEkS <br />[VERETT,WASHINGTON <br />The Undersigned %-� <br />Hereby applies for permission <br />At the following <br />APPLICATION FO�� RIGHT-OF-WAY tiSE PERMIT <br />�-e' <br />�. ��% . <br />PERMIT <br />.[: l-I..=.. �_ �._..�;,. <br />'�= n` - tF..a <br />�. �� N� / !.�/! . ♦ <br />10 ri 0 4�.�';,y � <br />� <br />,��; `- � <br />! %NSTr"fCG <br />� — — <br />N�"-r � <br />TH�S �o�,GE��/ <br />GtJr� �'JG?" =�'L,�- <br />, . .��� ���,:.�.� �-iJ. -- �� ,� <br />ORIVEWAY SECTION <br />NO SCl�LE <br />� � <br />{ I" LIP <br />���t•___—_____ �30" I <br />.1 <br />COPY OF l'HIS APPLICATION TO I <br />BE POSTED ON JOBSITE. � <br />C�LL ENGINEFRING DEPT. 259 Li; i i I <br />24 fiOU!{S QF=pRE CO�ISTRUCTI�)h';� <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />S�dewalk <br />�-lG�-�� /�-Ld�Pnn �/ <br />I�ctor's Signature <br />�G <br />ate <br />Note: Original to Customer <br />t Copy co File �. n q n 4 <br />1 Copy [o Inspecmr <br />.} <br />�-r,��s;%',,,,,; i: _,, <br />,t o <br />�,- . � � <br />H�-�/b. : �c �' � -�-"�;'.�'�v') <br />� _ <br />� V �r, �j <br />�; . <br />:�ic=.� �'- ' �.— <br />'�% <br />� G, <br />�The undersigned owner hereby 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 />'� �� tion and maintenance of the improvement hereto <br />� `� f% applied for and further agrees to remove same upon <br />notice from the Ciry and to repiar, public properry <br />-� ��� damaged thereby, re � r� G � l! vnp.a <br />p"r `" __�._�,�.��..���j ���.cf'/ <br />�� <br />;tr� Sic�natu ! of Applicant <br />.,'� .j `v 2 3�z i � f l, W,. s� A tl u <br />' ?� , i� Address <br />- �'�' Nf�ls-�3oy <br />� Telephone Number <br />�/ � �� �6 <br />Dare — <br />--, .-�� ',—�• <br />Fee . <br />Dept. A -noval <br />Engineer r 3 �� � <br />Water 4. ef /L% e-s cle ��.8-�' : <br />Street r ' : -, <br />n���t� <br />� � Ccmmunications __ � <br />Traffic � t ' <br />Planning. . �• . � �- 7� <br />S.W 6/i, ��' � y, si V .R✓i'� ,. <br />Approved by �� �/ T/ <br />Date A�proved !� <br />