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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> 10263 <br /> CITY ENGINEERS 7,S -/39 <br /> EVERETT,WASHINGTON PERMIT NO. <br /> The Undersigned '( ' u ti.1 <br /> Hereby applies forparm!ssion to 00IVj7- �� r A AlT J.YL✓ — <br /> At the following location S L n (D h r� S"T ' _— <br /> „- f- yr----r ury PL Al r<_D <br /> SKETCH <br /> (Work to be done) Yi <br /> i <br /> Zo' <br /> I � I <br /> th <br /> h <br /> LN <br /> I <br /> l <br /> I <br /> V <br /> CRR <br /> IDD RT <br /> A/FU! AS PH A T D1141 <br /> �cE 0F <br /> FNA U&AIT <br /> u0 CURa Cf cvrrcrz <br /> DRIVEWAY SECTION The undersigned owner hereby agrees to hold and <br /> NO SCAL€ save harmless the City of Everett from any and all <br /> rr---- /9' ---+I claims for damages that may arise because of installa• <br /> f I„ LIP tion and maintenance of the improvement hereto <br /> applied for and further agrees to remove same upon <br /> notice from the City and to replace public property <br /> darpzer�thereby <br /> , n •,J � <br /> 45 1 t.) Signature of Applicant 4 O <br /> --- -- - ZsUZ:. <br /> COPY OF THIS APPLICATION TO Address <br /> BE POSTED ON JOBSITE. <br /> CALL ENGINEERING DEPT.258811 DI11N. Q L()lJ 1►1. Telephone N_ �7 <br /> umber <br /> 24 HOURS BEFORE CONSTRUCTION Date <br /> ---- -- ----- 8 /� 75 7 <br /> so <br /> CHECK LIST Fee <br /> Wetar Valve i @pt. pprovels I <br /> Drainage <br /> Curb 81 Ginter Engine <br /> Sidewalk Water- <br /> ( Street ' <br /> Communication "�9'1�� <br /> Inspec�ature Traffic <br /> ;, r i j Planning t; <br /> Date <br /> Remarks <br /> Note: Original to Customer <br /> ICopy toFile 10263 <br /> 1 Copy to Inspector 's'p d y 9LCiC/ <br /> Date Appr ved <br />