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APPLICATION FOR RIGHT•OF-WAY USE PERMIT � I
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<br /> CITYENGINEERS ����, � ,
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<br /> � EVERETT, WASHINGTON PERYIIT N0._� ?�" ; � S� a'v�
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<br /> � DFIVEWAY SECTION The undersigned owner hereby ac�rees to hold and ' �
<br /> ' NO SCALE save harmless the CitY of Everett from any and all '� �
<br /> I"-- --�--� claims (or damages that may arise because of installa- �',
<br /> I" LIP tion and main[enance of the improvement here[o �.,
<br /> � applied for and further agrees to remove same upon '
<br /> 30'�I — I 30'
<br /> (�-- i --^}�—� notice (rom [he City and ro replace guhlic properry '
<br /> da/p�aged tliereb � � �
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<br /> Signapture of ApPlicant (/ " t� i
<br /> � COP'r UF Tlil� t�i'f'LICp� � - p. . _ Addres� �l �J 7 4 l �.
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<br /> BG POSTED ON JOCiSITE. I -�.; `%- G 0 � f __
<br /> � CALL ENGINEERING DEPT. 259�881'� I Telephone Numher' '
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<br /> � �>�1 HOURS REf-�lRf= CONSTRLJC7�i.�;�.1'. Date � -- �
<br /> CHECK LIST Fee �
<br /> Water Valve De Ap rovals . .,.-
<br /> Drainage �. .
<br /> Curb&Gutter Engineers �+"�-� '�
<br /> Sidewalk Water :l`,�.:-� ' � ;�n %�,;� ',
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<br /> , .- . �- .-. - Street - �_/ � '�.
<br /> Communications ��
<br /> Inspector's Signature
<br /> Traffic
<br /> Planning_ ��,
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<br /> —�te ii�i, �.lO"��_ Ii — ;i"�-t�=�aF^z^•.y�.-�qr �.«, �i�.�-- ' .
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<br /> Remarks — '
<br /> Nute: Original ro Cus[omer - '.
<br /> t co�Y co F�i� � n�,�
<br /> 1 Copy to Inspector ' - � Approved by ;
<br /> Da[e Approved
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