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CVC 1 <br />y �� <br />CITY ENGINEFRS <br />EVERETT. WASHINGTON <br />APPLICATION FOR RIGFiT•OF•WAY IISE ERMIT <br />The Undervgned _ ________�___ _ <br />Hereby aPU���'s fnr permissinn ro <br />At the lollowing <br />�Wark to tre done) <br />Oi71VEWAY SECTION <br />NO SCALE <br />r_ _ _- - � <br />I \ 1 �•� UP _�� <br />�90+_ __. �30�; <br />i.�.�'Y�il illl'.�,:I'�'ll�:l�I!�i'Jl�i <br />�;! i'll',I!11uf1.1(11L'SI1L <br />Cn; L f f,��liJl (HING UEPT.:5D1",i i <br />i.111��UrtI;ItIJ�OI�f C�7P1:1R�1Ctl�r!; <br />CHECK LIST <br />Water Valve <br />Drainage <br />Curb & Guuer <br />Sidewalk <br />(� .l�- �/�}fl�n�------- <br />In/�Mrq��ignamre <br />6 <br />�a�e �-� G ---�-�..7� — <br />f �emarks <br />Nnte: Original toCustomer n <br />1 CopV to Pile � 1 l' 7 6 <br />1 CopV to lir,pr.ctor <br />11076 <br />PERMIT N0. / � � <br />Thc undcrsigned ownen c�re6y agrees to hold and <br />save harmless the City of Everett from any and all <br />r.laims lor damages ihat may arise because ol installa <br />tion anA maintenance of the improvnment here[o <br />applied tor and further agiees to remove same upon <br />notice Irom ihe Ciry and to replace public property <br />damaged thcreby. , <br />/ ' / � � <br />Slgnature of llppl�t ��•�-p � ---- <br />� _� ' ..'111�°=' L :L� <br />Addr ss <br />-, " � .-, �: iJ <br />Telephone Number . <br />�/ /' �,� - /-7 7 <br />�_�t <br />Date <br />Fee r <br />�ept. Approvals <br />i <br />Engincers_ _ �1_.__� _ <br />Water_ <br />Communications <br />Approved by <br />Date Approved <br />