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,_,.,..._� <br /> F.PPLICATION FOH RIGN i-OF-WAY USE ;�ERMIT <br /> cveren _! (�[:. �:- <br /> � <br /> . <br /> CITY ENGINEERS - "� ': <br /> EVERETT, WASHINGTON PERMIT NO. � % j �—__ � <br /> The Undersigned_ ���,�J�� ', .� ''�'/''--- - : - •�=- ' � <br /> i <br /> Hereby applies tor peimission to '' •i� ' %�' � 1 , � "'`�'�r''�`�''—L�_� � ��� i <br /> , ' <br /> ' /, /'•: =;.-i I <br /> Atthefollowinglncation_1�-��'`� �`' �� ~ � — - <br /> SKETCH I <br /> (Work to be done) <br /> , . .(.i... , . _ i <br /> a <br /> � <br /> J <br /> I <br /> I <br /> DRIVEK'AY SECTION The undersigned owner hereby agrees to hold 3nd I'I <br /> No SCALE save harmless the City of Everett from any and all , <br /> ..__ -----�ll claims for damages that may arise because of ins[alla� <br /> �.__ tion and maintenance of the improvement hereto j <br /> �" ��P ' appl�ed for and further agrees to remove same upon � <br /> I 30' � __.—�3� notice from the Ciry and to replace public property � <br /> r--� -�- ---�—�� dam��e� iheraby.,:' . . II <br /> �i7f,% /' /.1;>,, ; , p„��, <br /> Signatureof Applic�nj �� , -. ;,,,_ . i <br /> �.� ;.,.0 /� !L% � _ _ .. . .� . <br /> _. <br /> �. 7F T'HIS APPLICAT'Of,�TO ' Address ,/ , ;iG <br /> � .`:TFD ON JOBSITE. . Telephone Number I <br /> � �nl.L CPJGIPIEERING DEF f. 25�J�£381 7 �� �-�= ''7 ____ '. <br /> '. HOUNS BEFORF CO�I�TRUCTIU��' Date ' <br /> � „ <br /> � i„� j <br /> __..--- �—�—'i . <br /> CHECK LIST Fee "� J- �- <br /> Waeer Valve Dept. ApproVals I <br /> Draina9e �� <br /> Curb&Gutte: Engineers � �� �*•^"� , <br /> Sidewalk Water. <br /> S[reet <br /> Cc:nmunications <br /> Ins;,ector's Sionature Traffic -- � <br /> Planning - , <br /> bate <br /> Remarks <br /> Note: Original to Customer �1 Q�1 ! <br /> 1 Copy to Filn Approved by <br /> ' �opy to Inspector . __ __ <br /> Date APProved----- ' <br /> � <br /> � <br /> L - <br />