Laserfiche WebLink
a <br />CITY ENGINEERS <br />EVERETT, WASHINGTON <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />_0009 <br />PERMIT NO. '/ "T —12-4— <br />The Undersigned t-l' I l_LI S " O M I— S 1J L <br />Hereby applies for permission to _tom N S T/2 A ZSr C o ry C- <br />p Zt �A 4 <br />T <br />At the following location % O —j — <br />(Work to be done) <br />COPY OF THIS APPLICATION TO <br />BE POSTED ON JOBSITE. <br />CALL ENGINEERING DEPT, 259 <br />24 HOURS BEFORE CONSTRUCTION <br />CHECK LIST <br />Water Valve <br />Drainage t��t"L D <br />Curb &Gutter <br />Sidewalk _ nroae <br />--50 -24' X,r,r <br />lnspector s nature <br />Note: Original to Customer <br />I Copy to File 10009 <br />1 Copy to Inspector <br />: ne unuersignea <br />owner hereby agrees <br />to hold and <br />save harmless <br />claims for damages <br />the City of Everett from <br />that may arise because <br />any and all <br />of installa. <br />tion and maintenance <br />of the Improvement <br />hereto <br />applied for and <br />further agrees to remove <br />same upon <br />notice from the <br />City and to replace <br />public property <br />dame ad there y <br />Sign ure of <br />pplice— <br />.S <br />Address <br />Tene <br />Te ephone Ny <br />tber <br />bar <br />Date <br />0 <br />D <br />Fee <br />Dept. Approvals <br />3sYz 8 <br />:TY <br />Approved <br />Date Approved <br />ND <br />SCALr <br />w <br />