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evcrctl <br />� <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />Thc Undersigned I S I'll. 7- �y <br />Hereby applies for permission to � <br />APPLICATION FOR FiIGHT-OF-WAY USE PERMIT <br />�. 0 3 (? ; <br />PERMITNO. � ' ' � <br />,�-''� i i i ';� t,/; ,; <br />At the foliowing location �'.� A'U _� � C l�_ J I� .._. <br />/ . i . '/'. <br />SKETCH <br />(Work to be done) <br />�� L. ��: i�lU L��U�I � L;�'•il_ t <br />' , `'�!�,H _'� C:.L,`��'!!� <br />n <br />� I ����� ',�j.7L j� <br />_'nl : IINI: :Ufi L'�. ,s ll I 1_ I� <br />SID? :�Jrall< <br />'� <br />. G^nIVEWA7 SECTIGN <br />NO SCALE <br />� � —_ J�.l--1._. <br />+ I��u <br />, _��— ______— ya—.�..�_ <br />I <br />COPY OF THIS APPLICATION TO �i <br />BE POSTED ON JOBSITE. <br />CALL�i�7GIN6ERINGDEPT 7_50-8£;It. <br />'�I IInU✓, ��i ! UfiE r ���'SIL;J� �IUfi�. <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />Inspector's Signature <br />Remarks <br />Note: Original to Customcr <br />1 Copy to File ;� �`? j� r <br />1 Copy to Inspector <br />L��l,�;��� �J�- <br />+) -/�-- /� <br />_''�' <br />n <br />(:` <br />•.i <br />_ 1i � ! I. <br />8Lh ST <br />� <br />Sv <br />L <br />The undersi9ned owner hereby agrees to hold and <br />save harmless the City of Evere[t from any and all <br />claims for dan�iages lhut may arise because oF installa� <br />[ion and maintenance of the improveinent hereto <br />app!ied for and further a9rees to remove same upon <br />notic from the Ciry and o replace public proper[y <br />dam ,e�J er by. , � <br />•�i �� %� j'a.iG^-� �C� <br />Si na[ure pf Applican <br />( <br />Addres14�� z � , T <br />% � <br />Telephone Number <br />�U L�� � � ���3 �C p� <br />Date <br />Dept. Approvals <br />Engineer ��`' % "e�;�,::..�� �C_/' - /�:.-. <br />Water � ��/ 1� � 5 <br />Street k��� ,' ,.,,/ <br />Ccmmunicatioqs"�' � � ��---•�' - �n��`� I`� <br />Traffic ���'�li�- -�----- 1�yT'/ " <br />Planninu - ����� I�I�%�7( <br />Approved b�y ,� .- <br />. .. /i', , . , <br />Date Approved � <br />