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�_, _ . . . .,.._....... _ '_' <br />� APPLICA710N FOR RIGH7-UF-lVAY USE PE.RMIT <br /> everett 11�0 0 0 <br /> i � <br />� CITY ENGINEERS PERMIT N0.���Y Z�� ' <br />. EVERETT,WASHINGTON I <br /> i � � <br /> TheUndersigned ����.-_���.� �'�J�LLJ /'LV��y�- _ - <br /> Here6y apPiies for Penais:ion m����'/T� � 2 /� � ����/y `T ��/ ) .— � <br /> � <br /> � At the fol�owing location_�10���_.—��11C �'� - — <br /> SKETCH j <br /> (Work m be done) � . <br /> Cj.'':�r� ��%��G/�r '. <br /> � <br /> � <br /> i <br /> ' OFiIVEWAY SECTION TLe undersigned owner hereby agrees to hold and �, <br /> , NO SCnLE save harmless the City of Everett frem any and all i <br /> . �_ __——� claims for damages tha[may arise because of installa � , <br /> tion and maintenance of the improvemen,7 herero <br /> ��.�" ��P _J applied for and furthcr agrecs to remove same upon � <br /> L 30' I notice from the Ciry and to replace public properry <br /> f 30�--� ---���-1 darJr�gedthereb . �I <br /> �r, �.�.� /��o�� � 5'J U� � <br /> I Siynatu of pPlican[ ! . <br /> ... . __ __. _ .. ._ . Addrtss � , � ' <br /> rCOP" OP THIS AP'LICATION TO �,(. ,ll ��:C�'_.�./ , / -��` � <br /> i BE POSI"ED ON JOUSITE II 6� �"���� i, <br /> `Celephore umber � <br /> � � r�L�_ LtJ,INECR�tJGC��P1. �598ftti �` �� �1'�"l�i" _ � <br /> � ,i1fiSB' : Ul�.i_ '.�h;ilOftll Date � I <br /> : -. 9,-i,-- �,------ ' <br /> CHECK LIST Fee /!�% A . <br /> Wacer vaive Dept. Approvals � <br /> ✓ � ICurb&Gutter Engineers c;._. ��.�'�' "� <br /> Sidewalk W�Lef � <br /> Street I <br /> __ _ _ _ _ _ Ccmmunications — i <br /> Inspector's Signaturc Traffic -- � <br /> Planning — �i <br /> -DSte <br /> Remarks _ � <br /> Note: Original to Cusromer 1 n _ ' <br /> 1 CoPY to File 1,,L 0 L'0 APProved by �, <br /> i Copy to InsPector _____ � <br /> Date ApP�oved <br />