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Approved By <br />L,9,e(�G,4.r�n 'L�%�G ?�/�� aZ /9 72 The Undersigned <br />Date Approved <br />Hereby applies for permission <br />SKETCH <br />(Work to be done) <br />n�U <br />The undersigned owner hereby agrees to hold and save harmless the City of <br />Everett from any and all claims for damages that may arise because of the <br />installation and maintenance of the improvement hereto applied for and <br />further agrees to remove some upon notice from the City and to replace all <br />public property damaged thereby. <br />Inspector's Signature <br />Date <br />Call [ngineering Dept. 259 8803 <br />24 Hours before <br />snnstruct;- ' started. <br />AftmcmovlT CROSS/MG <br />3 ' wfoe DjrcA _ <br />rva7F/z <br />3/04 <br />1 S'111 ti <br />SWOAS <br />-)�- T, e ssr•c sys« Y s w. G.. .sca.�r�f•:.�r <br />Variance Required <br />Yes..........— ........ <br />No.......... _.... ..... <br />Signalure of Applirant <br />Address <br />—/. C� <br />Telephone Number <br />9i,..,t / J 7 Z <br />ate <br />$ A10 1=6P,:' <br />I" <br />DEPT. A ROV(1LS <br />Engineers <br />Wator — <br />Stree <br />Communications <br />Traffic ,-73-,�� � V's7 <br />Plannin '�� <br />e "PTT WITH WATER <br />CHECK V ITH'WWFUNF. <br />DEPT. FOR WATER Mfg-e:AVATION <br />LOCATIONS P`-7E EXCAVATION <br />