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<br />Approved By
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<br />The Undersigned �'` "' `'f�+•a•-z "�, f'�"'��,v. � Daie Approved
<br />Hereby applies for permission fo ��'''� � �� � L 'c" , i', � � : i'� = ': N''- - _`
<br />i�. :c ✓ � ' � ,.i d. • ' .�C >�t.�o,(�v.
<br />At the following lomtion— �� �� ' �'.J, � / � � �/
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<br />SKETCH �
<br />IWork to b� onel T__
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<br />The undersigned owner hereby ogrees lo hold and sare harmlrss Ihe City of
<br />Everetl from ony ond oll claims for darnages that may arise because of the
<br />installalion and mainlenance of fhe improvement hemto applied for and
<br />further agrees fo remove samc upon nolice irom the Cily ond lo replate all
<br />public property damogcd thereby.
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<br />Inspedor's Signalure
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<br />Dafe
<br />Varionce Required
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<br />Yes.______......_....._ �L.. ic��
<br />No. _ ............._..........
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<br />� 'isi� /r;;�din% 6t� , �,,, �. , ,-.1 -s-., �. �,/N/ DEPT. APPROVALS
<br />ncmorRs - Engineers
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