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tl'r evcrelt <br />, � <br />CITY ENGINEERS <br />tVERF.TT.WASHINGTON <br />APPLICATION FOR RIGfiT-OF-WAY USE PERMIT <br />The Undersigned _ � s � � � <br />Hereby applies for oermission to _% �_�� - �-+ � <br />A[ the followirg <br />(Work to be done) <br />'�� '.y . _ : V.��' <br />--`1 .- f-i %''j /-0_ i;':� i) <br />�RIVEWAY SECTION <br />NO SCALE <br />r---- - - - � <br />�— I�� LIP <br />30" —_...__— __—__ . . _�30 I <br />y� <br />�.COPY�,FT�i!�!'�PPLIC�V�IUtd-IC ��, <br />i I;[ PC5TED ON JOBSITE. � <br />�' � ��L E(�IGIN"tERING DEPT. 259�8811', <br />� <br />�': i IOU RS GEJ�OR� COfdS � RUCI IOiJ I <br />�� - -- . __... -�----. __.: <br />CHECK LIST <br />Watar Valve <br />Draina5e <br />Curb & Gutter <br />Sidewalk �, � <br />Inspeclor's Siynawrc. <br />Remarks <br />Notc: Original to Customer <br />.p P� e <br />1 Conv to F;Ie q t11�� ��l <br />1 CopY to Insper,[or <br />PERMIT <br />�.VO�� <br />� �c <br />The undersigned owner hereby a9rees to holcl and <br />save harmless the Ciry of Everett from any and all <br />claims for damages that may arise because of installa� <br />[ion and maintenance of [he improvement hereto <br />applied for and furthe� agrees to remove same upon <br />notice from the Cily and to replace public property <br />damaged [hereby. . <br />� <br />SignaturR af pplican[ <br />i . <br />- � <br />Address" � / � <br />� iG/�;:r,�c:� y;�Yi� <br />Telephone Num�ber <br />Date <br />. : . i � . . • 7 :� <br />Dept. Approvals <br />Engineers <br />Water <br />Cammunications <br />Approved by <br />Date Apprwed <br />