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rveren ' APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />, � 10606 <br /> I CITY ENGINEERS <br /> EVERETT, WqSHINGTON �CD - ��`� <br />' , PERMIT N <br />� The Undersigned �� '' ' � � ' � "� -- <br /> i --^— <br />� Here6y�rp��r.s for p=rmission tc :"`�•� ' L '�"�- � _.., _ `1;,�-'h ✓j, .i <br /> _- �. ._. _.s ' . --„=�.. _. <br />� At the toilowing loca[ion - • / - ��v <br />, � SKETCH ` - -..4.— - -.- --- <br /> ' (Work [o be done) <br /> � <br />, , i i ;_ _ <br /> (�s— �- ----------- �� _ <br /> _---- <br /> i ---�-- <br /> .i . . ._.---._...--�--.. <br /> - t <br /> /��'—�— I ,in( t � <br />��� , l ) �,`t/3 S Ll� �� �� <br /> �' rt��I ._.—"____'—._'—".'."___ _ <br />�I I I � _�� ��/ti� ���� <br /> � �^,/ a-�G,I <br />� , �%� <br /> , � `� l �c���rqsA� I ) <br />� ; � ��ed<<' � <br />� �y ��-� � - <br />� n <br /> , <br />, � � � <br /> � � <br /> � ��:� ;� <br /> , ��. <br /> � , <br /> , 1,. _� <br /> I � � ! J`I^� <br /> I VI <br /> I •` I <br /> � " <br /> —__�� --�.��_� <br /> '�j I ------_"'_---'�-�'3 �� ----��----------`----- <br />�� � eij <br /> ' GeivEWAY SEC710N The undersigned owner hereby agrees to hold and <br /> . NO SCa�E_ - save haimless the City of Everctt from an <br /> �"--- -- ---`� y and all <br /> claims for damages that may arise because of installa- <br /> 1���n� tion and maintenance of the improv?ment hereto <br /> I 30" <br /> r---�.--.—_________�j_30" I applied (or and further agrees to remove same upon , <br /> �� �� notice from Ihe City and to replace public prope�rty <br />� . damage�l thereby. `� Jy <br />' � � r.��...._' �. � �,t. �_�r-c. ,f 4t <br /> � Signature of AppliE t �� ' <br /> - -_. .. _ ___ . _.. ' � � i �i T!.. �� t. <br />� I �COPI' OF THIS APPLICATION TO ,� Address - <br /> I BE POSTED ON JORSITE � �_ S r y � �I <br /> i i CALL [NGIPJ[�RING DEP?. 259�8311 i Telephone Number ' <br /> � ��, y./ � 7/ % � <br />'' ��. � 24 I10URS RGFORE CODdSTRUCTIOP!I Date i � <br />�i . _.. __ . _ .._ _ _ .: '. <br />� CHECK LIST �� � � % 1�__�_��— <br /> 1 <br /> Wator Valve Fee--`-�c:i � � <br />` Dra:nage Dept. Ap�rov IS <br /> I Curb&Gutter <br /> Sidewalk Engineers <br /> Water - <br /> '� Street .Y,.z'-�`�, - - ,'_ tns��.c�-�� .: z`�Z <br /> ^ T 4 <br /> � �L " 1 � �_� i <br /> �n�t�5 r ignature Ccmmunications .�:��_ "�4'� �;w,.r� ,, ✓�A.;C/r <br /> " t. <br />� Traffic � � <br /> �.- <br />, �/-� _ � J Planning <br /> -b�te <br /> �4�(C�L <br /> ,.____� r f> �.�1� e-!_'IG�t l <br /> �t,f,,_ <br /> Rem�rk <br /> Note: Original to Customer � . <br /> 1 Copy to File 1 �C('� C _ � <br /> 1 Copy to Inspector U �� C� <br /> Approved Ly <br /> I <br /> Date Approved � <br /> 1 -. <br />