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�,�,i,��,�� APPLICATION FOR RIGHT•OF-WAY USE PERMIT
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<br />CITV ENGINEERS
<br />EVERETT, WqSHIN�3TON
<br />The Unyersignr.d _ _%���_�./ �r-J%� (.� JON/�� `;(�%1/
<br />PERMITNO. /�-// ��.���
<br />Hereby applies t�� permission to _ C��-� ����CT �- J�rtir)L % �k�/1/f_ �✓/a �S
<br />f�Ni� L�)ND`-� �i�a� n�i� h-n_w- �
<br />At the following locntion__ �%�z4 _ c O� fC ��� �l/� �✓ /� /�. . --�-
<br />SKETCH -.--____ _ _..._
<br />(Work �n be done) C__�-.��_ � * �_�
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<br />DRIVFWAY SECTION
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<br />CHECK LIST
<br />Water Valve
<br />Drainage �
<br />Curb & Gutter
<br />Sidewalk �
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<br />In•,��eC�n�'s Siynature
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<br />Rrm✓rks ..___..—_. _ __ _.._._.._
<br />N�,i�� U� �.una� to Cuetomer
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<br />Dh'/VE bdAY - `�,
<br />The underslpned ownc� I.,�ii�by agrees to hold and
<br />s:rve harmless the City ul Eve�cu from any and all
<br />claims fm dama9es ihat may urise because of install;��
<br />�ion and mainlenance of Ihe improvement herelo
<br />applicd for and lurther a�rees m remove samc i�pon
<br />nolice from Ihe Ciiy and to repince public �'�.ouerry
<br />damay terc ry. �
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<br />nature o.' Applicant � ---- "
<br />A�tdress � ��-��_s-- _ . -
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<br />T�lephone Number
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