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�•��•��n <br />� <br />CITY ENGINEERS <br />EVERETT, N'ASHINGTON <br />i <br />TheUndcrsigned -��� �'� � <br />Hereby applies for permission to <br />Atthefollowing <br />SKETCH <br />(Work to be done) <br />u <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />_ � � <br />y � '_ ..I� > �,/ <br />� �t�t ���l i-A. rl+:��� <br />ORIVEWAY SECTION <br />NO SCALE--_ _ � <br />� � <br />�f� LIP <br />L I <br />1_3�—_ __—�30_�1 <br />I- <br />ICOPY OF THIS APPLICATION TO II <br />BE POS7ED ON JOBSITE. <br />CALL Ei�1GINEEftING DtPT.259�86111 <br />��?�1 fIOUI,'.�. REi�OIiG CONSTRGCTI� <br />CHECK LIST <br />Water valve . �,r'.� . <br />Droinage �. - _ . - �� <br />Curb & Gutter <br />Sidewalk <br />Signature <br />Note: Original to Customer � � � � <br />7 Copy to File � � �� <br />1 Copy to Insp�ctor <br />d ,^ <br />;r <br />. , ,: .-a.^ .. . .. <br />`` 10839 <br />��--: <br />PERMIT NQ. - " � - <br />t <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of E�rerett from any and all <br />claims for damages that maY arise 6ecause of installa- <br />tion and maintenance of the improvement hereto <br />applied for and further a9rees to remove same upon <br />notice irom the City and to-replace public property <br />r;fcLl�.Lal;�Oi _ <br />dat%�a�1ed}t1�12�71y�. ' !, <br />,z..r�.�<'� �../ /%� � ' � � .l,�`�r7e-� � <br />- �'Signa�ure ot Applicant ��� <br />- %% .�...:�� �"r.r_,^ f.:%' . <br />Address <br />:! � — - �� �, ? _ <br />Telephone Number <br />Dept. Approvals <br />Ccmmunications <br />Approved by <br />Datc APP�oved <br />