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6...'r . 4-r-. ,�.� c. <br /> EVtki'.i, WASH. J Approved By G-� <br /> /�/ 1 n.�. � i9'/ <br /> The Undersigned _ / ,� r'1 V �"_ cJ'S � l t I� �J Dare Approved <br /> i <br /> Hereby applies for permission to- � n�n < '� C1 ��; ;i %�� ; <br /> c..� <br /> Af the following location �'��(� /"'1��i lrn � //J <br /> �` <br /> SKETCH <br /> IWork to be donel <br /> �� Q g Y� O � � 0. �_' �, � . <br /> --- ---_ _ --- ___ _ _ � <br /> �y�aw <br /> � � �y� _ � <br /> . <br /> � VS' <br /> I �] .rC, <br /> I r � ={ ::�� !� f�j <br /> � I <br /> i <br /> i <br /> � <br /> ,� � , � <br /> � � <br /> The undersigned ownen c�reby agrees to hold and save harmless the City of Voriancc Required <br /> Everett from any and all claims Ior damages thal may arise because o( fhe <br /> Ycs......__._............... <br /> installotion and maintenonce of the improvement hereto applied for and <br /> (urther agrees to remove same upon notice from the City and ro replace all No..... ......._......__... <br /> public properly damaged Ihereby. <br /> �- S Ti=//�l <br /> �R1�GFNAY:;�-SECIIOH <br /> (titD_�'SCAtt) f/� ."`" `. <br /> �/'/��e{'[i�:7'� �- '�r-t`.:i.�i'r'`.. <br /> Signature o( Applicanl <br /> ,,�=:1 ._...._ �:-,.�•�, /�✓ i'ii��cJ?,.,r�j.,,�/�t'�"��r-c� <br /> ! FQ'_.__. . -_,--- �'i .._ <br /> �. ;�j: (? _ � `'� .,j��` � .,� Ad ess .. <br /> �;_- — ,.,�.5.+' ,.;G11 � <br /> Telephone Number <br /> _._.........� <br /> _..,�y..,_,�.._�^' ---- / � Dafe <br /> �r�r�i <br /> Inspedqrs Signafure $ 7 -�� �/� /� <br /> 7- 6 '- %i� � i .,C�' Fee <br /> Datr <br /> DEPT. APPROVALS <br /> Remarks <br /> Engineers � <br /> i <br /> Water_�.f ' . — <br /> Street � <br /> r <br /> Communiwfions �6'5-�.. +-�"'�':=-•-•-.:c._T. <br /> TraHie � �'`�:?_:• 7 - / '-7{ <br /> - Planning m��. ' �-- 7-�`7/ <br /> Call Engineering Dept. 259 SbO� PROVIDE <br /> 24 Hours hefore FOR ` l�JOT�' <br /> construction is started. PROPER DRAINAGE I CHECK WITH l��aTER <br /> DEPT. FOR ' q, �, ; � a�- <br /> _ / <br /> � In_ �i�n�� [� � r�- i � <br /> r. _ .t'.4�Ii�N <br /> I , <br />