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1 <br />��� <br />CITY ENGINEERS <br />EVERETT.WASHINGTON <br />The Undersigned L �� % <br />Hereby applies for permission to <br />-.PPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />10419 <br />>. <br />PERMIT N0. ��� <br />� �! ' ( L�^/ �� '�<; _ � <br />'�.CC c>��Y '�n. :�1- iur6 . .:/�.. r� -5�.� <br />Atthefollowinglocation_1`='--'�—'-r-""��-'`�'i`�'"'`� "�"�^�-'�'"`"'�"'� �--��= <br />c '/'�'` rlr�r � c�n /j �• C= <br />SKETCH <br />(Work [o be done) . <br />--- �a <br />j!-.: .i <br />,A.�� _-' t'` <br />^ : �'-� <br />�.i. , i ,. - . <br />_ � _'" �i <br />/ `( <br />1 <br />' I <br />�, ORIVEWAY SECTION <br />NO SCAIE <br />� r - � -� --� <br />I'� LIP <br />�30T__-r __.— ___�30 I <br />�� <br />� COPY OF THIS r\PPUCATION TO � <br />BE POSTED ON JODSITE. <br />� CALL ENGIN[EI11NG DEPT. 259�6811 � <br />"'d HOURS IIEf-ORECONSTRUCTIONI <br />CHECK LISI' <br />Water Valve <br />Drainage <br />Curb & Gutter <br />Sidewalk <br />/1 <br />i � . <br />-�-�-`�'� - ----_--- <br />- Inspecfor'sSignaw e <br />_�/// - ` % <br />1 <br />Note: Origiiial to Customer <br />1 Copy to File 't ��� 9 <br />1 Copy to Inspector <br />The undersigneJ owner hereby agrees to hold and <br />save harmless the City ot Everett from any and all <br />claims for damages that may arise because of installa� <br />[ion and maintenance ot the improvemen[ hereto <br />applied for and turther agrees to remove same upon <br />notice from the City, aneLto repl�ce public property <br />damaged therebY� : `� ����� /� /� , - �`;� �._.- <br />� " ' <br />/ i:J ,"_y_�� (� �. :J <br />SignaWre o( Applican[ <br />i,� /- -�r� /�/•.!.1/.r� <br />Address " � C`�bG�(1 <br />Telephone Number <br />�_'.! / �aG�[> _ <br />Communications �' --'-"- - <br />Traffic � <br />Planning �� `� /'' � f.�.- ' _ %j, <br />.. -T----..--`-:=,''L' f,` 5�;�, ,�==: '� <br />Approved by � f� � <br />_ _��., i `;,�, �� <br />Datc Approved <br />;� <br />