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everett <br />� <br />CITY ENGINEERS <br />EVERETT, WASHIP�GTON <br />:� <br />The Undersigned � � G��� <br />Hereby applies for permission to . <br />APPLICATION FOR RIGHT•OF•WAY USE PERMIT <br />10388 `;�' <br />� / <br />�/'.n � 9 <br />j PERMITNO. ! C% � `.i/ <br />�/�, <br />�"� T7-r.�.:J <br />r•��� , <br />At [he following Iocation L�� -� �-� l �'7'"' ' � �' —� ��� - <br />(Work to be done) <br />s �c L,47� � ;--. <br />, <br />. .. . -. . 'c:=� ��C-i<�L,;! <br />Cc, ✓sr. t�s:�rti��' >/�� <br />DRIVEWAV SEC710N <br />NO SCALE <br />� i j i --_ _. _—.! <br />TI <br />� I" ll P _.. � Q� � <br />��"i"- - ------ __— - , <br />'i CUPY 0F T'.Il� i:i'PLIC.:�,�i!U:: iU . <br />� �12 POSTED ON J06SITE. I <br />�_AL� ENGINEERING DE?T. 7>9-8811 I <br />=HOUIi� 3F_FORF��C-S-IRL'l1TIOfJ'. <br />CHECK LIST <br />Water Valve <br />Draina9e <br />Curb & Gutter <br />Sidewalk <br />Inspector': Signaturc <br />kJ <br />:J �� <br />-*=�-- <br />� � <br />�� <br />h '�l ` <br />.^ <br />SSLt/' �/' ..�� .(�v , <br />Rcrnarks <br />Note: Original to Customr.r <br />, ����Y ,,, F �,,. 9. 0� R g <br />1 Cul�y to ;ns���r.ctar <br />f�G�K E A�/�HH � T <br />s��r��� <br />The �indersigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and all <br />�J claims for damages that may arise because of installa� <br />` ,'� tion and mainte��a��ce of the improvement hereto <br />�� �� I, V? �� applied for and further agrees to remove same upon <br />�y �� notice from the City and to�feplace public properry <br />1��..' I � d��n�gedtherehy..:..`// .S,El�.Lf�//I% <br />,\ h � R,M � . : � , � ��LM--.� <br />•'�jV .;:` Sig ture of Applicai�� / <br />��' r', �' �i. �.i4l�� �,�� ���t.,f:�� l�F�-(.) <br />��,' Address _ � <br />� '� _� � .,- � _, <br />Telephone Number / <br />( ' �j � � � � I �'. <br />Date � <br />�. :.�J "�-.'-+c /L� �u / _iL <br />Fee <br />o, <br />(s. : ' <br />Approve� 3�.�� <br />_� <br />Date A�nroved <br />'� <br />