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_ _ _ _ . ,�- , . ___ , - - -. . - �-- - <br />- ��t<<�� <br />APPLICATION FOR RIGHT Or"-YVAY USE PERMIT 113 8 5 <br />`� ` <br />�. -: t;=lts <br />����i� lft 197g <br />CITY ENGINEERS �7 j ' � <br />EVEREiT,NJASHINGTON PERMITNO. %d - <br />TheUndarsiyned. CJ ��f:i�v�Cny. '!� ���t Gl��c'�i ( d-. i• <br />� _ <br />Flereby appiies for permission to C,,^�-,�y-,��,: ./ .� .S _ /7�> i �_;< «.::c � � <br />A[ the following <br />�Work to be done) � � . <br />� �"rt.�,4. .,�a��.�,�`_. <br />f. <br />oaivewnv sEcriou <br />NO SCALE <br />� ` fl•� lIP � <br />�°��--�------ -- -�30 � <br />COPY 0= TtiIS APPLICATION TO <br />BE POSTeD ON .IOBSITE. <br />CALL ENGINPERIMG DEPT. 259�6671 <br />24 HOURS BEFCRE CONSI'RUCTION <br />CHECK IJST <br />Wator Valve <br />Drainage <br />Curb & Gu[ter <br />Sidewalk <br />Inspector's Si9naturc <br />R?marks <br />1"1_38� <br />The undersi�ned owner hereby agrees ta hold and <br />save harmless the City of Evere[t from any and all <br />claims for damages that may arise because o( installa• <br />tion and maintenance oF the improvement hcreto <br />a�l�d for and further agrces to remove same upon <br />nJ�Eice�(`rom the Ciry and m replace pu6lic property <br />darilagetl ihereby. i � <br />� �-�� l �i� �.� <br />Signature of FlppLcan[ <br />�,�.�U i7'Ci.i z(y2i�-.rii> �t� <br />Addmss � <br />c�.g`:`f -`l�c:�+ <br />Telephone Number "— <br />/U --.7-7is <br />Date <br />Dept. Approvals <br />Engineers__ _ <br />Water__ <br />Street <br />Ccmmunica[ions <br />Approved by <br />GU=7'OME:� Da[e Approved <br />