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�V':2ETT, WASH. <br />/ q� <br />The Undersigned l'� i'�/U' ���` _ _ <br />Approved liy <br />,��c1f�i>� 9 /7 �;!, <br />Date Approved <br />Hereby applies for permission fo �ti� 7/�l� <- �"� �v _t�-S: '��'_.�� ��i �- � �/;�� . ��% - �� ' ` � T <br />% u /''�/; / <br />L/�/� ; /J / T ��.. �;:�.��:�:��G ',, _ ,<, ,vj` _r� ..>>; � F;. ��:,t�y <br />�=— — <br />At the following location__,/l� � .���`i`_��iy T <br />SKETCH <br />IWork to be donel <br />�� <br />__ _ __ --- - - <br />U/I' 1 � �; --� <br />� r f�l1,�'G D�iU. --�- <br />�1 j s5 <br />- -J_- -� �� - _.T- - <br />The undersigned owner hereby agrees to hold and save harmless Ihe City o( <br />Everett from any and a�l doims lor damages fhal may ari�e because ol thc <br />inslnllalion und mc,intenou.a u� 'he improvement herelo applied {or and <br />further agreen to rcmove same upon ,;oiice fmm Ihe City and to replace all <br />pub�ic propeny damaged thereby. <br />Inipeclor's Signafure <br />. � <br />SiTE �.s/FC�t'�O �� /7L� <br />Dafe <br />Remarkt <br />'l��'��R JeF"✓�'�- <br />1 - <br />k <br />�' .'I: . - :�5. , <br />Variance Required <br />Yee <br />No <br />�,i'. " . , '� .i� r- <br />1t� / � �J 79l �• r-- �* - <br />i ; � ; • � Signolure o/ Applicanl <br />� . t`�- <br />` ,'(' f• �`J���C�. ,��c*-�<:�n.--- <br />Addrest` <br />/� / f3EC: :i++ ST: <br />ielephone Number <br />"�37— � 72N <br />oa�a <br />5 �` <br />�.� �e.t- r;% <br />Fee <br />, � '/ <br />DEPT. APPROVALS <br />Enginecrty__���_ !/ ,c.{, �// y��i�Ti,� <br />Water�_ c:�,9.. . <br />Sheer ��� <br />Communicalions� '-y � '�^-��'�T - <br />Tmffit— 7,.�_ r „ --- <br />Planning..-�-� �"' �. ��'. <br />� <br />