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� <br />�' / ' �' <br />� � .�. :: , .- .� •. : '.�—. <br />� <br />. �,.✓ �%r!,-7 � ,✓ . <br />The Undersigned_ �-- • / , <br />Hereby applies for permission to <br />�/f- T�J r 'L /� . ✓�G^ =��.I/-?!%� <br />-�.f-i:� <br />At the fo:lawing lomtion <� � v �� r-- • <br />__,_. - _�.�..�.��:a..,a:.,ti�..:,:..:..>,�.,��..9...a;:,,::4,,,,�,,,«...,� <br />SY.ETCH <br />IWork to be donel <br />� <br />\\ <br />The undersigned owner hereby agre�s �o hold and save hnrmless �he City of <br />Everetl from any and all claims for damages thal may arise because of the <br />installotion and mainlenance of ihe improvement hereto cpplied for and <br />furiher agrees to remove same upon nolic_ irom the Cily and to replace all <br />public property damaged thereby. <br />+� //� <br />:� �/� � G �YJ`� ./�i_. <br />Inspec�or's �nafure <br />� /7 l � � <br />Dafe <br />�A p� <br />� ����/ <br />PROVIDE FOR <br />; �RO� E�2 OR;1I�JAGE <br />g't �O I <br />�c:�. �C� � , <br />D te Approved - <br />' [\oTE <br />CH�^K IVITH WATER <br />DE; T. '�;:Fi !�;/�TER LINE <br />LCCAT;Gi�;S [3EFORE EXCAVATION <br />Variance Required <br />Yes............................ <br />No.....__ ................... <br />�' -'Z00� <br />,:�1 C�- j � ) . . <br />lt,) i � F' � �✓t /-<l > > <br />� ' Sj§nalure of Applicant <br />� / "�lC? � ���n,un�� � ni� <br />Address <br />� %�L — 7?�'S <br />ielephone Number <br />7/ • <br />' Dale <br />� Z�,�v ,-,„'' --��G..,..�: <br />Fee <br />DEPT. APPROVALS <br />c.; 1�• LoIJ, �, . %� � <br />Engineers �� . , <br />Water � � �� i"rL_¢ <br />Slrecl � ��� � <br />fmnmunicalions_ ! .---:�'t '—=---- <br />�lanning <br />