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APPLICATION FOR RIGHT-OF-WAY USG PERMIT <br />every <br />0719 <br />CITY ENGINEERS <br />EVERETT,WASHINGTON PERNIITNO:- �77-_7 `3 _ <br />The Undersigned h !" 15 NA �O;✓ rJC'!1-" r! �� ____. ___ <br />Hoieby applies for permission to -e N S UGC , 20irV _ <br />At the following locationJ? 'I_ q-!! __- <br />SKETCH <br />(Work to be done) <br />DRIVEWAY SECTION <br />NO SCALE <br />- I'LIP <br />COPY OF THIS APPLICAI ION TO <br />BE POSTCD ON JOOSITE. <br />CALL ENGINEERING DEPT.2598811 <br />24 HOURS GEFORE COfhSTRUCTION <br />CHECK LIST <br />Ylrater VaiVe <br />Drainage <br />Curb & C,utlrr <br />Sldca_atk <br />Inspertnrl S�Jn.dure <br />I!nle: Cam •earl ra (:ustan••r <br />1 � � ,a I11••1Y gt.lr <br />5: ee 47-7-4C/-/ %v <br />The undersigned owner hereby agrees to hold and <br />save harmless the City of Everett from any and all <br />claims for damages that may arise because of Installa• <br />rj 17- 7 7 tion and maintenance of the improvement hereto <br />spy applied for and further agrees to remove some upon <br />notice from thf City and to replace public proporty <br />dalyaged lha by. , <br />Signature of ApplicanS <br />I•Sl: dA,5'G, <br />Address 1r - f <br />j 3-�. <br />Telephone Number (w..r-) 2s4- <br />-Z= 7_-3 27 <br />Date e" <br />1s=Lv�= <br />Fee <br />.Dept. <br />Approvals <br />Engineer, ___ __•_ <br />Water i✓.Yr/G�.LTJ.z!+a c <br />Street <br />COMITIUniCatianf <br />Traffic_-__-_. <br />PI; ninq_ <br />•Apluovwkny •. <br />C <br />