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The Undersig <br />Herzby applies for perr�� �s�on to � ��� �'r � S`%• t� "�'% ='r� S�Gi/ _ <br />At the following location___.� �' f%� �� ��� ^'r <br />SKET�H <br />(Work to be donel <br />� <br />Thc vndersiyned owner hereby agrees to hold and save harmless fhe Cily of <br />Everett from any and all claims for damages ihat may nrise because of the <br />inslallotion and mainlenance of Ihe improvement herefo applied far and <br />furlher ugrees lo rer.iove same upon notice from the City and to replace all <br />public property damaged Ihereby. <br />Sgnarore <br />Approved By <br />/l:'%'i/i= /->f'�/'� �� � f � <br />Dafe Approved <br />� <br />piW <br />� <br />� <br />Z <br />O <br />� <br />Q <br />¢ <br />5 <br />Variance Required <br />Yes_. _.......... _ _.. _..... <br />No.._......._._ ..___.. <br />j�f oTG ; CNEG� L�G,� i i���v' �F Gr/�r�=�.: sf���% ' <br />� <br />C��F B�Fo�E PLACrNG _���'�`�z- ` ��'�3,.,,�, 2�.�<. <br />� Sd nalure of Applicant <br />C_ G' -9 /C.. /-? �... .,'.l • <br />'��O n•'�0-c%�.G:���-� j % , <br />.r <br />ada�e�� <br />. 5 /TE C_:f1.�=C.C,�G7 f�����L <br />Dale <br />�,� /�/�'<�,C,.[.-NTiI�'� <br />� PF,OVIU:_ f'Uft <br />', ,��;n;-�i: ��rair�,�uF <br />.,�,�, <br />_'' t : �; i �Y <br />` NOTE <br />CHE�,K 1VITH WATER <br />bEFT. Fi'�n \'=A,iER LINE <br />� �_". �'; .:•.' t'c��Rf-, F.X(JAVATION <br />S� _ � 7� 7 <br />ielephone Nomber <br />Dafe <br />s �/n. l�.�:�_:: <br />Fee <br />DEPT. APPROVALS <br />.�y��".,��; <br />Enginecrs =-"G'6��� / ////7/ <br />Waler '��.�-- T. I l- I �- 7l <br />v <br />si���� _ — - <br />Communicalions�y �''"''�. "" . �� .. �.. <br />Tmffic ��''' ' � <br />Planning � �f S <br />Call En;�ine=rin� �ai t. 7ii!;�8803 <br />24 Il,ur, L•�fora <br />conslru�:[ir.n is siar,cr <br />