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��"���` "-1d�=.� /% /l�%% <br />The Undersigned �l �1 ,�: . 1= L f� K� Date Approv� <br />Hereby appiies for permission to ��1/� ST• �l C i T�/ �TA�I DA R D ��L'✓ <br />At the following location `� � t% � M A D f S C'� t�l _'7— <br />SKETCH <br />IWork to be donel <br />�— ��i � ,-_ ,�o, <br />Thc undcrsigned owner hereby agrees lo hold and savc harmless the City of <br />Everett irom any and all claims for damages that may arise because of the <br />installalion and maintenance of the improvemenl hercto applied for and <br />further ugrees to remove same upon notice from the City and to replace all <br />public property damaged thereby. <br />Inspeclor': $ignalure <br />, S/Ti; C/�rc-CF� ����yi <br />Dale <br />(� /�PG'.C/G,�T/C� <br />i PROVIDt Ft);1 I <br />; r'i?O;=ER Dit,11��i;GE � <br />i <br />I <br />Variance Required <br />Yes. .. ... _ _. _ _........... <br />No.__._._. _ ._........ <br />i / <br />� i�. ,t_.�i.� ./`/ .ii <br />Signafure of Applicanl <br /><-'�1 � !�" � � � ✓1 .S %� <br />Address <br />. . .; C ..." J U <br />Telephone Number <br />-- 'l — � / � <br />Dale <br />Fee <br />DEPT. APPROVALS � <br />����1 �� � <br />Engineers / ��� <br />Water_4-c�-��. % � //- 11-71_ <br />strcet -- <br />-j— <br />Communicalions ,Sl"' ���_��—�:Y�-� - �_ <br />Traf(ic " ' � <br />Planning l R 1-I S <br />Call En^i'ii�r;�if; Dzrn '155-;�93 <br />4 ��� � � 24 Hcur before <br />CHEC}C VJIT}I VJFSER construction is started. <br />D�PT. Fr,;< 4'dATFii Llf!E <br />LOCATIQP!:3 l3�FORF EXCA1'ATIL�i� <br />