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EVERETT. V�"ASH. <br />Approved By <br />�� <br />i r y �;, [/� i �CJ �l%% <br />I �. ? i � ` � Date Approved � <br />The Undersigned_ -- <br />i <br />Hereby applies for permis,ion to C r ✓ '•, � ; � �' '1, ' _ ' ; � ' '' � `-/ ' � � <br />At the following location ��� � /''/�iC� 1-ti n f/ <br />SKETCH <br />(Work to be done) <br />?2 <br />�'f <br />/ � <br />� <br />V <br />i <br />v <br />—t <br />6 <br />` <br />\ T—'�_. <br />—_._ <br />"_ L �,, <br />The undcrsigned owner hereby agrees ro hold and save harmless the City of <br />Everett from any and all claims for damagcs thal may arise because of the <br />insfallation and maintenance of the improvement heretu applied for and <br />(urthe� agrees lo remave same upon nolice from the City and to replace all <br />public properly damoged the.reby. <br />�i.0 WAY.��'V JL�C I.IO <br />tt� o-_-sc �ac e ) <br />!"�.�'�,�- -� �._ '---_.�� !� " <br />.'�``�_______�_ , �'�F _�__.i _� y <br />f �.' <br />Inspeclor's Signalure <br />_ S�/�/s' i�E�.�r/�/�'�7/ <br />Dale <br />Call �ngineering CcpL 259�8803 <br />?4 Hours befare <br />construction is started. <br />Variance Required <br />Yes...... ____ .............. <br />No............... _.... _..... <br />J � <br />a'' �r% 1 i%�: <br />.-,.,,; ._ _ � ignafu�'of Applicanf i <br />_: �: 3 3 ��,,�� , y�.,, �. <br />� <br />Address <br />3.�� - /C3� <br />Telephone Number <br />���� / , % <br />Dafe <br />s �� � /=e .� _ <br />Enginccis = � <br />Water 7 � <br />_ � Streef � � �.� r� <br />�� Gommunicafion! <br />Fec <br />DEPT. APPROV� <br />i . <br />t�' i.:'/ cv <br />j Traffic �%�c n r� .-: •� � <br />. �� <br />_ , Plannina —, <br />'rn_r_L.__—'ro{? ,�ND�G _'.-:-r.r. .. <br />i EHECf� �FJf�{�i�� �iNE ' <br />i i J'Lr Di�AiNAGE DEPT. FOR t^,� ��� ���tCAVA��n�J <br />' LOC:;rtO�S BEFOf ExCnva'i!": <br />\ _- <br />I—�__ . ...__ -- ---_�___ -_ _ <br />