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, eve:2lt <br />� <br />CITY ENGINEERS <br />EVERETT,WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />i��sa. <br />PERMIT N0. n J/ � �-5 <br />TheUndersigned ��� -�- ?y" — � , _ <br />lies for ermission to P/ - i` i` " T� r✓� c 7i .i`- i' ,: '°.,•'�,-'Y•' �ir. < F✓.._ <br />Herebyapp' p , <br />�� C T�i f O/ 7� l� 17" i-�'�=T'i /���li L�i��c r"�...� �?l•-,� T� i-:- <br />// i (...1 <br />At the following location <br />Z lf S n/ .r� N„ t-i'1�.i7 <br />(Work to be done) <br />k— — / I.O� -->1 <br />DRIVEWAY SECTION <br />NO SCALE <br />t.---- -----� <br />I <br />f 1'� LIP <br />I 30'�_ � _—. .. _ __...__�i'3O,'1 <br />��_ <br />�� <br />C,(�Pi OF- �l IIS �1f��L�G1T*ON I U <br />BE POSTGD ON JO[3SIl C-. <br />CALL ENGINEERING DEPT. 259�837 � <br />� IlOUIi.': I?LFORG CCf'1;TRUCTIO��! <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />I nspector's Signaw re <br />Remarks <br />Note: Original ro Customer � � � � � <br />1 CopY to f-ile <br />1 Copy to Inspector <br />� <br />TY�e undersigned owner hereby agrees to hold and <br />save harmless the Ciry 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 />appGed for and further agrees to remove same upon <br />no[ice from lhe Ciry an o�7eptace blic ( roperry <br />da ay�Q�ihereby. 5; �- � <br />Si o pplicant—�— -� ,,._. <br />9 h�� /�7'8� Sl,Sld <br />A�d�7�3 / 3/ z �,� (�Q 6 <br />�T21ep ne Number <br />�f � /��%� <br />Date <br />Fee ^/ V /- (� - . <br />Dept hoprovals <br />Engineers / � .�'�'�� � � — <br />water — <br />Communications <br />Q <br />Approved by <br />Date Approved <br />