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� <br />� evcrc�t /apPLICATION FOR RIGFIT-OF-WAY USE PERMIT <br /> i0 �"16 � - �,,, <br />; �, <br />, � � �c � <br />� �,-- <br /> I CITY ENGINEERS „'1 �.' J <br />� '.�'EREI I, WASHINGTON PERMITNO. - � �� � � <br /> ` . <br /> Thz Undersigned � � __ � �� �_ _ <br />{ Heieby applies for permissic� to � - � � � <br />' iil lhe (oliowing location - - �- � - � ��- - - <br /> SKETCH <br /> (Work to be done) <br /> I <br /> • I i <br /> I <br /> I �'� <br /> i i <br /> t Z: <br /> � ! _ . . . _ _. . . <br />� � I ,�..� ' " - � _ _ <br /> c, �,.::: � - <br /> �'� �� C , �-:!/ <br /> I <br /> I `n ' <br /> � � V �9' I <br /> i i `� � �� <br />'� - � ,?�,1 . - , <br /> I \` J v I <br /> � � � _ <br />� � � r�o -��.,: -.� �2�� � i <br /> � � , cJ,i�. r- %G�N'�-'�� .-,Y-;c;:: --- <br /> . . .. ;,:..._. <br /> 1-. <br /> <� ___"___ _-_ ._. _._.. _ _.. . . <br /> ` ! � <br /> �i � � � <br /> i � <br /> I <br /> I <br /> 1 I <br />� � � <br /> � <br /> ``/_ . '_ ' � -.. . _ i <br /> i ^ <br />� DRIVEWAY SECTION The undersi�ned owner hereby agrees to hnld and <br /> NO SCALE save harmless ihe City of Evcrett from any and all <br /> f'--- < <br /> �� �{ �,- claims for damages that may arise because of install�- <br /> ' �� ��.�`� tion and maintenance of the im rovement hereto <br /> i . I" LIP �) il�, �.' P <br /> i applied for and further agrees to remove same upon <br /> � I�30",�� _______ I 30'_� -� i; notice from the City and to replace public property <br /> � 't ;�If; <br /> � �� �^ � damaged [hereby. , � f <br />�� i �/�4 � I �(v � q� %/ _ � r. -`:✓� :��''�..�, <br /> _'�� $Igna[ure of Applicant —7' <br /> ' � '`- lf.°��� �/�. /J,n< <br /> i — - 1 � 8 7/_ T <br /> . COPY OF THIS FlPPLIC�4TION TO I : � ddres� <br /> 'i BE POSTED ON J0651TE. i _�S�.S-(.�.500 <br /> (.AI_L F�� ' - Tele hone Number <br /> 1GIf�EERING DEPT. 259�£3ii11 � �P- >n .- ��^ <br /> . "! '.10!i�S ;;i=f.01�1_ C.JP1STf-'UCTIUYJ�I Dd[e �� � � <br />� CHECY. LIST Fee � �- <br />` Wate� Valve De t. Approva <br />` Drainage �/ / <br /> Curb &Gutter ;4 �: Enginee� ,23 76 <br /> Sidewalk �� � / y� <br /> Water u n r P �hSC'F c !�'�'/�,� <br /> ( '✓. <br /> Street • ���6-�tic. � <br /> - \ _ 1 I .�: __ - <br /> - _ Communic�ib _ - <br /> Inspec_p 'sSignature '-' -' v�� <br /> Traffic' <br /> �� v � , .-� ��:� Plan�g ; , <br /> Datc .S�o(.v�r, - �-� io S 2�/' �9>, :;•: <br /> Remarks — <br /> Note: Original to Customer " <br /> 1 Copy ro File '� f� � '� ` . /J - <br /> 1 Copy to InsPectar . . .. .. � APProved hY- -:;,�_s� ,%/'., �/�,.r'--�.1/ <br /> Datr. Ap�iioved - -- <br />