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<br /> EVERETT, WASH. Approved By
<br /> L�CT0,4�r? .� /'l1'7,
<br /> Thc Undersigned � � � i � _� ' — . Da�c Approved
<br /> Hereby applies for permission to '��_ �-, r ' - � � ' .l.`. ` %'� ' pJ �f/ ,/=s / /f-r,,•� �1.,�• �
<br /> /i - ., �r< ,. ' ; L�%:vl
<br /> At fhe following location- "L "�—�
<br /> SKETCH
<br /> IWork to be doncl
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<br /> I i7s �(� (,T ^G �G r � sUPFr�,t'T c,�n.'rE. FO� OR.4�n/AC-E, 5F_r
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<br /> The undersigned owner hereby agrees to hoid and savc harmless Ihe Cily of Vmiance Required
<br /> Everet� Irom any and all doims �or domages Iha� may arise because of �hc Yes
<br /> ins�allaiion and main�enance ol th� improvemenf here�o applied lo. and , , No
<br /> (urlher ogrees lo remove tame upon no�ice irom �he Cily ond to reploce oll �;� � � �
<br /> public property dumaged Ihrieby.
<br /> ,�s/' �a,iA�. �¢"" GRA(/EL „ , . . .
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<br /> e _T�,�, � .. �� Signafu�e ol Applicanf
<br /> �__ _ CeM--rte uw.p ,
<br /> I ° D �� I� d00' 12o 'fL� N.C.
<br /> � • ,� , Address
<br /> uF'4 �'_ ._ wi •. 3�-Oi, ON�C� iwT[ ZTe
<br /> � _ s��.c��c,w,s•+, 4Eoo5"
<br /> Tclephonc Number ��,§•/L/0
<br /> /7:�/n�� i �c i1'. . r� � ! ` l �- O uTOif.R Z 1770
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<br /> Inspeclor't Signature A ,� t�v�+ •—'
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<br /> Da�e
<br /> DEPi. APPROVALS
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<br /> Remarks --- ��—_—�—�---�� --_—� [nginccrs_�i/L{.��/NL2'I �I/1L'
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