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APPLICATION FOR RIGHT-OF-WAY USE PLRMIT
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<br /> EVERETT!WASHSNGTO;J PERMIT NO._/ v � ��
<br /> The Undersigned �����<�•��� � _� �-f"� —
<br /> Herebyappliesforpermissi�mto �'��.�='-��.�� � � �� � ('�� -:�t - D�./
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<br /> li DRIVF.wAY SECTION The undersigned owner hereby agrees to hold and ��
<br /> � NG ScaLE save harmless the City of Everett from any and all ��
<br /> 'i � -------� claims for damages that may arise becaase of installa�
<br /> +i" LIP —�� tion and maintenance of the improvemant hereto` . ,
<br /> � — applied for and further agrees to remove same upon
<br /> � 30" '________ �„3� notice from lhe City and.to replace puiilic properry �
<br /> . damaged th(� e�� �
<br /> �, Signat re of ppl c nt �.. ,
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<br /> ' � COPY GF THIS APPLICATIOPJ TG �� Addr��� 3 s�U
<br /> �, I BE POSTED ON JOBSR6 '
<br /> Telephone Numhar
<br /> � CALL ENGIIJEEHING DEPT. 25&fl£;> > �. " / "`= �
<br /> � Date —��--} �=���
<br /> 74 HOUFiS 3E[-OR� CC)fd:T!iUCT�Of.i� . �
<br /> . _ - . .. . . �.� �- � ,� ,: �
<br /> ' CHECK LIST Fee �
<br /> Watar vaive Dept. Approvals
<br /> � Drainage �j � /�, �1% �� �.
<br /> Curb &Gutter En9inders�:��`..�_�`�� �U'� "L7— �,
<br /> Sidewalk Nlater �
<br /> �� . . - . Stree[ / %,i;'> - ,
<br /> .. . � .,,. _ . :,; ., ..
<br /> Communica[ions �� ,^'1 .'_;.��.�. ' :'+� �'- ��'.i; �
<br /> � Inspector'sSignawre Treff,ic_ -�r � ..
<br /> P.I�. ,,.--•.,- ,.-i7,r--,� ._��a�, �a�r..,.,� ,-
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<br /> �� -�te .. . �.
<br /> Remarks
<br /> Note: Onginal to Customer . �
<br /> � 1 CopY to File �_n 6 5 0
<br /> 1 Copy to Inspector Appioved by
<br /> �� Date Approved
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