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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> ev:•reQ � S C1 0 9 <br />, e 1U <br />� <br />� <br />� <br />� CITY ENGWEERS �" <br />� . EVERETT, WASHINGTON PERMIT NO.����_ <br />� TheUndersigned �7����%�,�� � Ld) �� �� �.��/��e• <br />: Hereby applies for permission to ����/7� � 2 � �T ,�1 ��;r��T n�i.rJ <br />' At the followin9 location C J�� 8 -� � � • -- ---- <br /> SKETCH <br /> �� (Work to be done) �� <br /> i <br /> �, `]f[� /�i%/�'..ifti I.. . <br />, ' <br /> I <br /> r <br /> I ' <br /> I <br /> i I <br /> i <br /> ORIVEwAv SEC710N The undersigned owner hereby agrees to hold and <br /> NO SCALE save harmless the City of Evere[t from any and ali <br /> f+--- ----- � -----1 claims for damages tha! may arise eecause of instalia- <br /> ! ;t" uP � tion and maintenance nf lhe improv��ment hereto <br /> applied for and further agrees to remove same upon <br />� � I ;p�— I —T ___ . ___ I 30'� no[ice from the City and to replace public property <br /> ��i �� �r ��� damaged thereby.. � <br /> �L�� /� <br />• . ;q� � J/ % V//I' �J/� / <br /> � Signature,df A icant <br />� COPY OF- THI i APPLICATIOtJ -f0 � Address /�� /!/ <br /> BE POSTED ON J�IBSITE. .. �~_���'�a; �/ �"�^���""~-�=—��- <br /> Telephone Number <br /> . CALL ENCiI;�[ERING DEPT. 259�RF1 ! � �'� �f- �j y��/ <br />� � 24 HnUI;; BGFOR[ COfdSTRUCTiOiJ�'' Date � � <br /> � /t' �I? <br /> i , CHECK LIST Fee /�_� � �/��� <br /> Wamr Valvr. Dept'FCpprovals <br />� Dreina9� c:�� /�� ���/' <br />� Curb& Gutter Engineers t�p._.( <br /> Sidewalk Water <br /> I Street <br /> j <br />� Communications <br /> i <br />� '. Inspector's Signawre Traffic <br />� ' Plannirg_. _ <br /> �te <br /> I Remarks <br /> ENote: Original to Cw[umer __ <br /> C 1 Copy to File 11009 <br />� 1 Copy m InsPector Approved by — <br /> Date P,�proved <br />