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Permit No.._...�.�D.��---.-- <br />CITY ENGINEE2S <br />EVERETT, WAS�I. <br />APPLICA7��t,N FOR nRIVEVJAY F'ERMIT <br />�€".�. �;r � �F , - <br />��,� �, -'� �'� � , � <br />r <br />`"`� c:�;;��.�;; <br />everet# <br />�L� <br />�, � / <br />l .,' � , L <br />- - � Approved By <br />r7`;/��r'/s T ii% /9J� <br />The Undersigned 3L� ��� `-� � �l � "' � Date ApprovedT— <br />r <br />Hereby applies for parmissinn to C � N �� �l (�..L'� ew��---=" �� � " rr'� �" �r ' `,1 ' � � <br />At the following lacation ti�� �''� A� 1�� 7� <br />SKETCH <br />IWork to be done) <br />� �; <br />2J <br />� <br />� <br />The undersigned owncn c�reby agrce: to hold and save harmless Ihe City of <br />Evereft from any and all claims for damages thct moy arise bemure of ihe <br />installation and mainlenancc of the improvement hereto applicd for and <br />further agrezs to remove saine upon notice from �he City and to replace all <br />public properry damaged Ihcreby. <br />v.Ew�.Y.'.� F,�CYION <br />(7JD.-..--5 C � L E ) <br />.� <br />. K,�'.�I En-: <br />�^•' ,_,__,.....;_ .-_. _.._�_ ._= <br />�`'�� ' �_F �_�_, �� _ <br />� ...:�.:. _�. <br />Inspeclor's Signalure <br />/ <br />. i/'%,ti �t-:�!',�i=:'� <� 7'/?� <br />Date <br />Remarks <br />i ^ <br />r�\� z- <br />I �T+ -- -- - ----- -- <br />I <br />���_ � �� <br />Variance Required <br />Yes__.. _....__........... <br />No. _.--_. _......._.._... <br />i � j ._ <br />j v '..;;(/....1 , � , <br />`.. � _ <br />. �.� . _ � r" �' � ignafu4e�iof �Applicanl � <br />� i f x, _ 3 3//;>> :��G� c t--,.� <br />Addiess <br />F_. <br />�y.: . <br />.;z:•; <br />r °��' <br />N �''. <br />3.f� - /(3�' <br />Telephone Number <br />�� Jate <br />$ I�� C� l-T- != <br />Fee <br />DEPT_ APPROVAI,S <br />-.'l.i ` / , " i <br />J��• j , , � � D,,.-/ <br />Engincers .... ' � �•�.'%`!.-. � ! 7/. <br />i <br />Waler T��,I � .�. - ii <br />ii <br />� -, <br />Sircc! ---.`_�.--. '- -_�.---�-`-- <br />