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�'.,�7,d�Caii°r---.._ .. ...,.,. .._...._ _ .. _ .. _.__ __.�_ <br />� .. _._.. ,,.. . .. .__. .. . . _. <br />::;:::... ..._.. . .. .. .. ..._ . _. ..... ... . . . .. . . .. . <br />evcrcr,'� APPLICATION fOR RIGHT-OF•WAY USE PERMIT <br />� -- _ �872 <br />C17Y ENGINEERS -7 <br />f_Vf:RETT,WASHIN3TON PERMITNO._?/ �G,,[,__ <br />The Undarsigned �G in/ALL Al�i t'Y �vE' <br />Hareby opplics for permiuion to Cfi N^ Y/,_J CT A Z �� fy G,•H A � T __�}/U� <br />._._� .._'_'_ �_`7 � _�—'__'�'�'..__ _'. _'__ <br />Atthefollowinglocation '�/,L._S� �-� YLy__���__ _ ` _ <br />�Work to be done) <br />j:- f- I a'7'I /'::. f�,r l-' <br />Z3� fo !'Oi�S7"tvtl�' <br />G�-,/vat %" ���� <br />DiiIVEWAY SECTION <br />NO SCA�E <br />� ----+� <br />� ua <br />�` Y —� <br />I--'�'�+- �- - . - -.I-'°"-I <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT. 259�8811 <br />24 HOURS BEf-OflE CONSTRUCTION <br />CHCCK IIST <br />Wabr Valve <br />Dreinage <br />Curb � Gutter � <br />SWewatk <br />Inspector's Sipnaturs <br />� - - <br />Remark� <br />Nop: Oripinal to Cuetomer <br />iCopytoFile 10872 <br />1 Copy to Inspacttx <br />The undersigned owner heraby aqrees to hold end <br />save harmles: the City o} Everett from any and all <br />ctaims for damages that may arise because of instatla• <br />tion and maintenanca of the improvement horoto <br />applicd for and further egreet to remove same upon <br />notice fro the City and to replace public�prpperty <br />dama d r�y(, �^� I_L_, <br />� {! <br />�-f... �,�qNi <br />Si�natu o Applicant <br />rj'���} �/ � ,t� S:• <br />Ad�fo55 / <br />�7yct�G. CSw • <br />Telephone Ny �by{�_ ; � � <br />3 <br />Datc <br />�..,3��.��%�7 <br />Fee <br />Dept. Approvals <br />Engineers <br />Water <br />Communications <br />Planning <br />.ipproved by <br />Dace Approved <br />