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EVERETT, WASH. Approved By <br />The Undersigned AF-721)9 l3Lre0TNEL ___ Date Approved <br />Hereby applies for permission to <br />At the following location y Jd — Mfi i' / S n <br />The undersigned owner hereby agrees to hold onrt 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 same upon notice from the City and to replace all <br />public property damaged thereby. <br />Inspector's Signature <br />5/Tiz /Z�ZZX . <br />Dale <br />4A TER ✓ <br />F'� �1, •, ,'.;A'� <br />Variance Required <br />Yes............................ <br />No............................ <br />5LA <br />�QrlllU2 �3�o%l�EN <br />Signature of Applicant <br />1-/2 6 - MA olso.v <br />Address <br />Telephone Numher <br />Date <br />$ N(9 jQ-E <br />Fee <br />S�LU <br />DEPT. APPT L <br />Enginee <br />Water r1-Z='-7 <br />street <br />)mmunicaf'o9s f'$ E�Cts-•� •..r s, <br />Traffic 5 <br />Planning <br />Call Engireedw, D pt. 2548803 _n <br />24 Hoer, b.-IC." <br />construction Is starlea <br />