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EVEkETT, �VASH. - --i,Pn����d ey <br />�- � �` � ` r � ��1 ?c `/�_____�� <br />The Undersigned�j[�11l1C� �, ��C 4(� (Y � Dale l,pproved <br />Hereby applies for permission <br />At the fo�lowing location _% �� /U (1 � 7F, f'l t� _ <br />SKETCH <br />lVJor;tc �e donel <br />l� <br />�-� a �1 t 5 0�.r <br />0 <br />The undersigned owner here6y agrees lo hold and save harmless the City of <br />Everett irom any and all claims fer damages Ihat may arise because of the <br />inslollafiun and maintenance of the improvemenf hcreto applied for �nd <br />furiher agrees lo mmove same upon notice from Ihe City and to replace all <br />pu6lic properfy d �maged ihereby. <br />�. /� '3. <br />Inspeclor's Signalure <br />�' 7;.:� � <br />S/� �- r, c:::�-t �7 ,.:�3 ; 7i <br />Dale <br />�::ill en�ineering Uept. 259�ES03 <br />�4 Hcurs beforr <br />�:onstruction is started. <br />f'7 <br />c'_ <br />F_xcep{;���r� <br />. <br />� <br />Variance Reqvired <br />Ycs...._._:....._._..__. <br />No.._. _.._...__..._.. <br />// /� , . / <br />/�' h� '�" f-' � �...G�:����'C�Ii<<l�.. j <br />Signafu�e of Applicanf <br />�/o J1,���-� • <br />Address <br />,3 S J � I S`J� G <br />Telephone Number <br />% ,;� 3 - � / <br />Dale <br />� I\1C1 (`�' C', <br />;s, <br />s£: <br />"r:"� y:.,:. <br />Fee <br />DEPi. APPROVALS , <br />Engineer���-� ��,�'��r� ��3/% <br />- Waler <br />? +�' i -•__ �; <br />— � Strcet " .c�.,� I, �zc�., l,_ � � <br />,_� <br />, PRO`I�DE FOR <br />' pROPER DRAINA�E <br />� _ �� _.. .._..._-..� <br />Planning <br />k r�oTE <br />CHECK WlTH WATER <br />DEPT. FOR WATER LINE <br />'+ LOCATIOfJS BEFORE EXCA4AFION: <br />d <br />