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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> CV11y 10101 <br /> CITY ENGINEERS <br /> EVERETT, WASHINGTO 1 (/�JPERMITNO. <br /> The Undersigned 'I�AJ A (�"'� � ?)A C �� C'�� e—Aa_ <br /> Hereby applies for permission to l C til S V? U C ( OZ <br /> If ,r LLyV Y — <br /> At the following location oT h S T1 Itt <br /> SKETCH <br /> (Work to be done) <br /> IURTION !1)T X30 <br /> K <br /> 422 <br /> � f � <br /> b <br /> MA h) Z rS E c 6c c t= <br /> GO Th STetff <br /> DRIVEWAY SECTION The undersigned owner hereby agrees to hold and <br /> NO SCALE save harmless the City of Everett from any and all <br /> claims for damages that may arise because of installa- <br /> tion and maintenance of the improvement hereto <br /> I applied for and further agrees to remove same upon <br /> 441 R notice from the City and to replace public property <br /> dame d thereby. <br /> Signature of pp rcant <br /> ---- -- -- S� — l <br /> COPY OF THIS APPLICATION TO Address <br /> BE POSTED ON JOBSITE. Cup <br /> tJ Teleph3S 3 -399 - 3ST- F <br /> one Number <br /> CALL ENGINEERING DEPT. 259 8811 4• /7 _ J_ 7 .-t <br /> 24 HOURS-BEFORE CONSTRUCTION �?'� rr (t/ Date r so G IZ-l7-7� <br /> rl"j <br /> Fee <br /> Dept. Approvals <br /> Engineers 7--Io r y <br /> i Water@'t-�—' -- <br /> Street <br /> , . r . C� Communications <br /> Inspector's Sign.M. Traffic_t /1• / .9L_ <br /> CPlanning <br /> ate <br /> Remarks <br /> Note: Original to Customer <br /> 1 Copy to File 101 n 1 <br /> 1 Copy to Inspector Approved b , <br /> Date App G I7 / 7 <br /> I <br />