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�PPLICATION FOR RIGHT-OF•WAY USE PERMIT <br /> evereU 10 y 9 4 <br /> � —7 <br /> CITYENG4NEERS pERPAITNO. � / `�¢ I <br /> EVERETT,WASHINGTON ', <br /> The Undersigned �L�-������ �j�'E- �I'�� � ��� �"/�7��` �y,�� -�� � <br /> Hereby apF�ies for permission to ��ti��7T � �-�--/ 'L�l��— � i <br /> A[the to',lowiny location_ ���� ?F � L�vE � �� — -- — , <br /> SKETCH � <br /> (Work to be done) —,.) �. <br /> ��. � � .,. /�' ,'i�"}"i' � ,- ' . <br /> v . <br /> ( ' <br /> i <br /> J <br /> i � <br /> 1 <br /> I � <br /> II I <br /> I <br /> � DRNEWAY SECTION The undersigned owner here6y agrees to hold and <br /> � NO SCALE save harmless the City of Everett from any and all <br /> ' ____—_.- --.1 claims for damages that may ari:e because of installa- <br /> � � � tion and maintenance of the improvement here[o <br /> � r� i" LIP applicd for and further agrees to removn same upon <br /> �. I ip, _ 30"J notice from the Ciry and to r?place public properry <br /> r� J.____ ---- - ---�--- <br /> , damag�thereby. <br /> i ' / i � <br /> , < %� l./ 1_i�J <br /> 1- -1-_ <br /> �� Signature� Applicant i <br /> _ , <br /> . . ..--- � -...----" . . . Address <br /> ��COPY OF THIS APPLICATION TC) � � / � ��� y_ ����� �� <br /> �� Br POSTED OPJ J0651TE. ��� <br /> Telep�—hone�u'mber <br /> I CALL [NGINEERING DEPT. 259�88i 1 S{'�-7 � �`��� — � <br /> � ?�; ;��OUR; BEPORE CO(JSTRUCTION�. Data /;_; S' _ '77 i <br /> CHECK LIST Fei: �' // `��'�� `"� ,1' � <br /> Water Valve Dept. /joproyals <br /> /,'/' <br /> Curb &Gutter En9ine�rs._._—/�:--�-�/.:-�'� � <br /> Sidewalk Water-------'-- - �— �' <br /> Stre�t------ ------- ' I <br /> _ _ Ccmmunications _— <br /> Inspecior's 5iynature Traffic__. i <br /> Pianning ��,, <br /> ._ _.__—__ _ ---- . <br /> � Date " -- �------ �. <br /> i <br /> Remarks � <br /> Note: Oriainal to Cus[omer <br /> 1 CopY to Filc �.r g 9 q F.pproved by <br /> 1 Copy m In:peetor , <br /> Date Approved <br />