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.------a*--- —�`— <br />� _. <br />� <br />� everet� APP��CATI�N FOR �iGHT-0E-WAY USE PERMIT <br />� � - <br />'� �.�'. 0�7 4 <br />, CITY ENGINFERS <br />' EVERETT, WqSHINGTON 7 <br /> PERMITNO. � '7Z. <br />� The Undersigned !' i i� - <br />� �_ <br /> li,' <br />�I Hereby applies for permission to � � — '—' <br /> i ' ' � <br /> At the following location t �i/ </ %�; _.!r .-..� <br /> � 'i� ,,-i_._.� , <br /> SKE i:';� <br /> (Work to be done) <br /> 5('c r1l / �I :-i-rc/� <br /> i <br /> I <br /> I <br />� <br /> � ORIVEWAY SECT!ON <br /> . NO SCALE The undersigned owner hereby agrees [o hold ana <br /> , r�----- --_� save harmless the Ciry of Everett from any and all <br /> �----- claims for damages that may arise because of installa� <br /> : I \ 11" LIP tion and maintenanr.e of Ihe improvemer,t hereto <br /> 30" I 30" applied for and fur(her agrees to remove same upcn <br /> �, —� � T� natice from the City and to replace public property <br /> dam�g� ther y. <br /> �li� �o <br /> Signamre ot A�licant — <br /> coi�v oF Tius n��ucarior� To �,3� ''�''-� ' <br /> � 6E POSTED ON JOBSITE � Address �_ <br /> "'�-�� dr <br /> i CALL EPJGWEERING DEPT, Z,�g.fSf',17 Telephone Number <br /> � I . .. `.:liE�i !iLFORE COtp��l-i1LIi:lItJPJ, —'`���� � � 7 � <br /> -� - .-.. . . Date _. <br /> CHECK LIST i�—,�� — 7 � /�. ��� ���� <br /> Water balva: Fee i _ � <br /> /1 '- , � ' <br /> Drain�ye DB t. A <br /> Curb&Gutter P, PProyals <br /> Sidewalk Engineers '�___�Y_f��_.�, � ' <br /> � <br /> --�_ <br /> Water <br /> St}eet <br /> Inspector's Signature Ccmmunicntions <br /> Traftic <br /> Planning <br /> I <br /> at-155 e— _ <br /> Remarks <br /> Notc: Oriqinal to Customer <br /> 1 Copy ro Filc 1 �" ' -� <br /> � I / �!. <br /> 1 Co�iy to In;per.tor - � APProved 6y <br /> Date Approved <br />