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APPLICATION FOR RIGHT OF-WAY USE PERMIT <br /> W10492 <br /> R <br /> CITY ENGINEERS IO <br /> EVERETT,WASHINGTON PERIVITNO. 7G- lO3 <br /> The Undersigned R rno 4 u2 n , W. r <br /> Hereby applies for permission to ro n sT r f I - <br /> /'( n b n I 1 O�w /9rJ/n .�f.Jrtt/I`S!,^.9PF <br /> At the following location 19 1)4 RD <br /> SKETCH <br /> (Work to be done) <br /> a _ <br /> Lnnd3c uyvA "" `r` <br /> R <br /> U/w �- <br /> LTyP& ..45., C.,rC <br /> A -.pl+ Pvy. ca. <br /> Vnpn�d <br /> Ll I LLI <br /> LI <br /> 1401 Q <br /> Lot 21 f <br /> I P_ <br /> 7 <br /> r/` No Scale fA <br /> DRIVEWAY SECTION a .I. F& The undersigned owner hereby agrees to hold and 1 <br /> NO SCALE save harmless the City of Everett from any and all <br /> --- 35 — claims for damages that may arise because of installa. <br /> tion and maintenance of the improvement hereto <br /> I" LIP applied for and further agrees to remove same upon <br /> notice from the City and to re lace blit property <br /> damage <br /> Sign r p c <br /> COPY OF THIS APPLICATION TO 4't"1 11Address s <br /> BE POSTED ON JOBSITE. <br /> Tele on umber <br /> CALL ENGINEERING DEPT. 2598811ZJAJP r' C <br /> I746 <br /> 24 HOURS BEFORE CONSTRUCTION Date / 17- 1 <br /> CHECKLIST Fee <br /> Water Valve , <br /> Drainage /i a fl�� 6 <br /> Curb&C er i� \ Engineer <br /> Sidewal Watery <br /> Street-,4_ .� <br /> fr Communkati <br /> Ins ig ature Traffic <br /> Plannirl I ]V <br /> _15-st—e Srluo' _ <br /> � I <br /> Remarks <br /> Note: Original to Customer <br /> 1Copy to File 10492 ./ <br /> I Copy to Inspector Approved by <br /> I Date Approved <br />