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EVERETT, Vv, <br />Thc <br />� <br />Appraved By <br />.-., � " / 7 <br />J --�.i�.�:.�=- , <br />Dale App�oved <br />Hereby applies for permission t� ��VSTa�. -`u� F � Lk /Q` -f��'�� �r -� -1''F�°��•'''pry <br />i <br />Atthefollowinglocotion—�'��s ��• ���L ���• -- <br />SKETCH <br />IWork fo be donel <br />3eJ. g��� <br />. , <br />n�' Przor��=k"° 5���4�t: s w <br />Thc undenignnd ownen c�reby ayrees to hold and save harmless Ihe City of <br />Even:`t from any and all daims for damages that mry arisc because of Ihc <br />instaliolion and maintenance of the improvemenl hereto opplicd fo. and <br />sunher agrecs lo removc same upon noticc from Ihc City and to replacc all <br />public properly damaged ihcreby. <br />Inspeclor's Signalure <br />SfT,� �_ilFGit'Fi� �i-.�/-7/ <br />Dafe <br />--�i��.� ir/flG,c" ���nJs%6'C�,r.-i� r��=rc�,e� <br />ReRarks <br />�.�.j<f�T �%��'��C��",:�/� <br />�!` <br />� ,.�I <br />' F:O'TE :� <br />G-7_CK y�'ITfI l'/�17CR \ <br />� � . �, ;';i�T(:it LIPlE \ <br />i, <br />r��Rr.. f X(`AV�1T�'1•'w <br />v�;���« ;����«d <br />Ycs <br />No. . ..._... . . <br />� <br />c.� /..�..�ii.•, .) <br />� � <br />� <br />„ /.! <br />> �': '..i , F : � J'_1.,.�,._'.,-,� <br />' Si;;natur�� o( Applicanl <br />� f <br />� �� � � ���_ ,: <br />Address <br />Telephone Number <br />Dafo <br />�.rr <br />$ '-� ° --` <br />+�iWaler �� <br />$Ireel `�� i�� <br />Communications <br />Tmf(ic <br />Planning _ <br />Fee <br />DEPT. APPROVALS <br />. __ . � <br />_7 <br />