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evcretl <br />CITY ENGINEERS <br />EVEP.ETT, WASHINGTON <br />The Undersigned <br />Hereby applies for permission to <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />1C�1i16 <br />At the following lor.ation_.: _. '�_' � <br />(Work to be done) <br />C.'IVEWAY SECTION <br />NO SC4LE <br />— -- _ -J <br />F - � <br />�.�-_-I!" �IP _-�� <br />�_Sn� —_.�---- _ I 30" I <br />i �r' � <br />��"'.GPY Uf- iHIS NPPLI::ATION �i0 � <br />ItE POSTED ON.:OBSITE. I <br />_.',;.L FfdGI���GRING DEPI".259-8E1 i <br />.1-'� iIOU!;S [iF�UHE COfJSi�RUCTIOP!�� <br />CHECK LIST <br />Water valve <br />Drainegz <br />Curb & Guttcr <br />Sidewalk ' � <br />Insper.tor's Sipnawre <br />Date <br />Remarks <br />Note: On9inal to Customer <br />� 1 Copy to File � ri t'' -� �j <br />1 Cupy IO I ��l5peclor <br />= i " <br />- -}� . r . .� , <br />z <br />PERMITNO._ � � --'��- <br />-" i'". , <br />The undersigned ewner hereby agrees to hold and <br />cave narmless the City of Everett from any and all <br />claims for camages that may arise because of installa- <br />tion and maintenanc� nf the improvement here[o <br />appl�ed for and further agrees to remove same upon <br />��. notice from)1�'e Ci� and lryrepl �Q.pii��roperry <br />�da7ia ed'(hefebv� �� // <br />� � �.�-, i .'� . i �/.�i..( . . - <br />_, � ? - ��- � V — <br />Teleph�u�n�e N� ymber <br />-:1L"1-��L� `='�'-� <br />Date <br />, " � <br />Dept. Approvels <br />Street_ <br />Ccmmunicutions__ <br />Plann <br />Approved by <br />Datc ApP�oved <br />