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everett <br />e <br />�:IiY cNGINEERS <br />F1/ERETT, WASHINGT0�1 <br />APPLICATiON FOR RIGHT-Or-WAY USE PERMII' <br />10060 <br />PERMITNO.�� ����C <br />T!ieUndersigned �i���l�'� �. ���N��/::�t--t_� <br />Ncrebyappliesforpermissionto G�T�-�S�-Z. � �r'j � ���� ���Q� ���)���_ <br />� <br />At the following location__,:5 G O�- -- � L�^T �"r, �j, ��, <br />�Wcrk to be done) <br />�,r�,—ri—i S�'f= Sa�l.. <br />�--- — — — — — --�--- <br />- - - �°� -�i '� � _ � <br />— _ � rf///,I 0. , ' , �EDG� o�F �Au�T, <br />�r. � rs.. .o •��+� <br />3a oz.• <br />DRNO SaC �EECTIOIJ �� � � <br />�---- _ _� T <br />I�� LIP <br />�30 ___—_____—�30�,f <br />ICOPY OF THIS A.�ii'LICATION TO �;' <br />BE POST'eD ON JUbSITE '�. <br />CqLL EM1!GIMEERIiVG DEPT. 259�8R I 7. <br />�'>4 H'vJi;S Rl:FORECONSTRUCTIOIV�� <br />CHECK LIST <br />Water Valve - <br />Drainage � ' <br />Curb & Gutter <br />Sidewalk <br />k c�.. N�t��'- <br />Inspector's Signature <br />�1-Lo --�y <br />at�e � _ <br />� ..��-6. r/li.�i �i( � /i.i (� � I_ ..,. . ' . <br />� � � i q:''<� � , .� � . � � . . <br />Remarks � � �� <br />�_, . <br />Note: Original to Customer <br />1 Copy ro File <br />1 Copy to Inspector <br />�' Cc.' o <br />No <br />ScA� <br />The under,igned owner hereby agrees ro h�old '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 />applied for and further a9recs to remove same upon <br />C-notice from the City;and.to replace public property <br />' d maged the eby. � ) �' � ( �-� <br />Si�eof�pl�ant���', � ����J �� <br />�`. (� �!:U�( �I �� <br />A dre�ss, /--�y- �. <br />1� �tR 11 1✓G � �.i e-+ '. <br />Telephone Number ` � <br />� <br />Date <br />__ ,`, -� ' � 1 ? J <br />-7t�� ���- � �-�o-zy <br />Fee � <br />(; � Dept. Approvals <br />�Er��neer����/,�( � � ��,�.� `=l-i.O_-ic: '. <br />Water \"��� — ' <br />Sveet_� C:;,�;Q _ _ �� <br />� - -- <br />Communiczt�• ' <br />Tiaffic_ � � <br />Plannin� � /�'�, <br />�.no�� — <br />Approved by v f <br />/ y <br />Date A�ed r <br />�/����n <br />