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EVERETT, WASH. <br />By <br />el <br />The Undersigned taI o 11 r R D M 'Z �. Date Approved ' <br />t-Ie.eh.. nnntinc In.- nermissinn to C ON) 57 . A SZA A)0 A lz D r ITV :5 AV <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 nll <br />public property damaged thereby. <br />NOTE CH6CK Z ;Co17X7r✓ <br />OF K/+77e'-� 5f1617— Off <br />13EFd2F pL,g4=1 /G 4::o1V0eF",;e <br />Inspector's Signature <br />11111171 <br />Date <br />PROVIDE FOR <br />PROPER DRAINAGE <br />NOTE <br />CHECK WITH WATER <br />DEPT. FOR WATER LINE <br />LOCATIONS BEFORE EXCAVATION <br />Variance Required <br />Yes....... <br />No............................ <br />f%�va hd /'// ,Ze h C <br />977z, <br />Signature of(9p11cant <br />vZ o .Z �19��%�: Al2nr—s7— <br />Address <br />Telephone Number <br />Date <br />$ Mo FFF <br />fee <br />DEPT. APPROVALS <br />, / —r!-7/ <br />Water- - <br />T <br />Street <br />Communications - !''a %��^-•'� �'^ <br />Traffic'' <br />Planning <br />Call Engineering Dept. 259.8803 <br />24 Hours before. <br />construction is started. <br />