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� �..� <br />;" APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> i �`'� � (17 L. ':, <br /> f CITY ENGINEERS . � <br />� eVERETT, WASHINGTON PERMIT N0. _ <br />� The Undersigned _% � <br /> j Hereby applies for permission to ! � — � � � � " — � ' .� <br /> I <br /> i i1i liie iuliowiny lucatiun % �. i / � - �' . <br /> SKETCH <br /> (Work to be done) <br /> �RiVEWAY SECTION The undersigned owner hereby agrees to hold and <br /> NO SCALE save harmless the Ciry of Everett from any and all <br /> {�— — ----- - -� claims for dama9es that may arise because of installd- <br /> i <br /> �I�� LIP J tion and maintr.nance of the improvement here[o <br /> applied for and further agrees to remove same upon <br /> I 30" —� '�o�� notice from the City and to replace public properry <br /> r --�- �{-=--� <br /> damaged thereby. ,� � <br /> Signature of Applicant <br /> � Address <br /> ��C:PY OF THIS APPLICATION TO � . <br /> � ��.�;G PpSTED ON J06SITE. ����`� <br /> � Telephone Numl�er <br /> .. �;_L ENGI�1F�FiIf�1G DFP"i. 2ti9-R871 ��� / � .= 7 <br /> . IiGU;1S f:Pi (illE C(li�.�-�.-I I�;'�.IC: i�:' DdtC '� <br /> CHECK LIST . Fee <br /> Water Valve Dept. Approval5 <br /> Drainage , � . <br /> Curb&Gutter Engineers - <br /> Sidewalk � . . Water � <br /> �� <br /> �� /J Streei _ . <br /> ,��j'� � �`�.�..�' Communications <br /> �_� < <br /> fnspect6rs Signature Traffic <br /> � I1) � Planning_ _ <br /> Date / � <br /> Remarks <br /> Note: Original to Customer <br /> t Cupy to File � �i � 1 . <br /> I Copy to Inspector Approved by . <br /> Date Approved - ---- <br /> � <br /> � <br /> i <br /> �waur�S1�F� <br />