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_ - 3 _-_ <br /> APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> everetl 1 Q 7:� r <br /> e <br /> CITY ENGiNEERS , ' <br /> EVERETT,WASHINGTON PERMIT N0. S'� <br /> The Undersigned �. .{..,✓..:�.'.;. � ,- �--� y � <br /> Herebyappliesforpermissionto �. �,��-:..- ,.. ; �1 1-; � �I:�n.ai � n/vi <br /> .—'— — <br /> , <br /> T Y n <br /> At the following location i.s'.� % ,� t u< r> i� ,. „i .�.���- � ,,,, , ` ; � ' ''r�- � <br /> SKETCH <br /> (Work to be donej <br /> 5 / ,' �a �;,.�� �+ =�, ' <br /> �• <br /> � ORIVEWAv SECTION The undcrsigned owner here6y agrees to hold and �' <br /> ' NO ScaLE save harmless the City of Evemtt trom any and all <br /> ("— --�-- � � � � claims for dama9es that may arise because of installa� �� <br /> +�Y' uP � tion and maintenance of the improvement herero � <br /> apPlied for and turther agrees to remove same upon <br /> 30'��_. ______ ____�30" I notice from the City and to replace public property <br /> .� <br /> damag thereby. `-�- <br /> �l 01� 7 <br /> nui'UYILc-E �� r O �. <br /> Si�nature of Applicant � <br /> iui �,5- 357t H ✓c Sbi <br /> � Address <br /> . � (:OPV OF THIS APPLICl1l IINi i�G <br /> �� BE POSTED ON J06S1 TE. � -��7 — �a� <br /> , CALL ENGMEERIUG DEPT. 259�8ci 1 � ielephone Number - , <br /> 3 ' � N - 7� _ � <br /> � 2� !IriUR> �EPORE COUSI�HUCTION� Date �9 <br /> � . _. . . . . . . . . �'��� .�rc. �. <br /> CHECK LIST Fee <br /> Water valve Dept. Apptovals <br /> Drainage q t . /7� <br /> Curb &Gutter Enyineers_��,���'� � <br /> . Sidewalk Water "% -�i �'i .i`� - �,��o � f' � . <br /> — y.,. T- � --� <br /> � Street <� r} -I .-,.,..;� ' <br /> y`�(/�� _ � Cammunications ' I <br /> Inspector's Signature ` ' <br /> Traffic <br /> � � /�� 7 7 Planning <br /> / ,� � <br /> � at�— S •. � ' - � i �.... a ,y,, ,� ��.r . <br /> --�_�_ T�. � <br /> Remarks <br />� Note: Oriyinal to Cus�omer - � <br /> 1 Copy tu File � (i �� I) <br /> a <br /> 1 Copy tn Insper.ior Approved by <br /> i ! <br /> Date Approved <br />