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APPLICATION FOR RIGHT-OF•WAY USE PcRMIT <br /> evcrett i.p 9 g 6 <br /> V <br /> CITYENGINCEAS pEfSMITNO. ��� � � <br /> EVERETT,WASHINGTON <br /> �/-F���«%,�J , �,�,�s <br /> � The Undersigned�� -l��`� �S�J����-� ��LCJ <br /> Hereby appPes for��iermission to C � ���T �� � T � <br /> �-<—� y � v�_�� — <br /> At the following location_�y� -� ' <br /> SKCTCH <br /> (Work to be done) � � � /q �-;/_��� � ��� <br /> `7 _ , i <br /> I <br /> r <br /> i� <br />� � <br /> I <br /> ,� <br />' I <br />� The undersiyned owner'nere�y agree;to hold and <br /> DRIVEWAY SECTIUN <br /> NO SCALE save harmless the City of Everett from any and all <br /> - _..! claims for damages that may arise ber,ause of installa� <br /> � � tion nnd maintenance of the improvement hereto � <br /> � t I" LIP � applir,d for and further agrees to remove samc upon . <br />� . � ' 30' _.}.30"� notice from the Ciry and ro replace public properry <br />. I � �--" ---- damaged thereby. a <br />' ! '� � %����� �SJ J�J <br />� � Signa�e Applicant <br /> I <br />� � - - --- � - Address .� . <br />' , �COPY OF THIS APPLICATION ?O �� ��y�y ,�'�,��w�j i�� <br /> BE POSI�ED ON JOBSITE. I 'felephone umber <br /> CALL �'dGINEERING [>EPT. 259�8f11' � S� 3� 7�" U��y <br /> Date <br />� , 2d I-IC7UHSS RFFORE CONSTRU�:TIGfdi � � S- . �7�} <br /> i <br /> i � CHECK LIST Fce �� �J �''� <br /> Dept. Ap rovals,, <br /> Water Valve i7, <br />� . Drainage � -* -� <br /> Engineers <br />' Curb&Gutter <br /> Sidewalk Wa[er — <br /> Street <br /> ' Communications � <br /> Inspector's Siynature Treffic — <br /> Planning <br /> ate <br /> Remarks <br /> Note: Ori9inal to Customer <br /> 1 Copv m File 1 n tj Q � tipproved by <br />� 1 Copy m Inspector . _-___-- _ <br />� Date Approved <br />� <br /> i� <br /> I <br />