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, <br />�[ APPLICAT!7N FOR RIGHT-OF-WAY USE PERMIT <br /> S eV'=` <br /> � �.oss5 <br /> � CITY ENGINEEFS PERMIT N0. ��� L��J <br /> EVERETT, WqSHINGTON <br /> The Undersigned�='���JTI�/� � �.t�/LL /{j,� <br /> Herebyappliesforpermissionto Gn,( )h�y 2� �% ��f�;jf(� r ��J <br /> r — <br /> � � At the following location r�5 �C'TL/ _ �//� �. <br /> SKETCH <br /> (Work to be done� <br /> j: -� i-�'j i��(::/" =� � <br /> I <br /> � <br /> r ' I <br /> , <br /> I <br /> i <br /> � <br />' ' ' <br /> I'�, ORIVEWAY SECTION The undersigned owner hereby aqrEes to hold and <br /> NO SCALE save harmless ihe City oi Everett from any and all <br /> � � claims tor damages Ihat may arise because of installa� . <br /> �. +p� ��p —� tion and maintenance of the improvement hereto , <br /> I� , applied for and further agrees to remove same upon <br /> . <br /> i �30'„�__ ._ __________ . ___+30� notica from the Ciry and to replace public property � <br /> i <br /> �- dama� there6 . � <br /> �i . �'.rJ c� "/-/ <br /> Signa[ur of Applicant ' <br /> COPY OF THIS APPUC�TION TO ! Address � ] • � <br /> � � <br /> ! <br /> I BE POSTED ON JOBSITE. , /" � ./''�tc� �f/ /- /�/�� � �l, <br /> Telept�one Number T <br /> ' CALI_ ENGINEERWG DEPT. 259�3F3ii � —i� �� oyy� �. <br /> �� i ?-! FI{);_i;,C !;;=FrJ!�'. CCi"-1 (;UCTIUi�I Date <br /> i � <br /> CHECK LIST <br /> Water Valve Fee �/� i ���. .' i <br /> Draina e Dept._A Prov/als <br /> Curb &Gutter J "/ � <br /> � 9 Engineers G�__� i _ <br /> Sidewalk Water � <br /> ; <br /> Strcet <br /> --._______ Cammunications <br /> In<pector's Signature Tratfic ' <br /> Planning <br /> —bate —�-- — -- <br /> Remarks <br /> Note: Original to Customcr — <br /> , �a�>Y �o F��� 10 g 9 5 -- <br /> 1 Copy to Inspector Approved by <br /> Date Apprwecl — <br />