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CITY EIJGINEEGS <br /> EVERETT, WASH. pproved ey <br /> �% <br /> Ck}ober 23 , 14t�q <br /> T/ii . : ,•,� ., �,.;•;...�_.�� Date Approved <br /> The Undersigned <br /> Hereby applies for permission to � ' �'-��� • ��,��' ' '% �-` <br /> �i C� /�'='�� ,E=' < . <br /> At the following location - - <br /> �-.. _., . . . .. ..._ - ..,� <br /> SKETCH <br /> lWork to be done) <br /> I1� <br /> �• <br /> The undcrsigned owner hereby agrees t�- hold and sove hormless thc City of Variancc Required <br /> Everett iram any and all claims lor damages that may arise ber.ause of the <br /> Yet_....__......__....... <br /> installation and maintenance of fhe improvement herefo applied for and Na <br /> ._. ._.....__....._... <br /> further agrees to remove same upon notice from the �ity and lo replace all <br /> public propeny damaged thereby. <br /> �.��.t�,�t.�.�i <br /> /. / �. <br /> �i: ,' ' -� �,. �`«..�_�.-,;.: �.�, <br /> j -�� / � Signalurc of Applicanl <br /> z ,�,����� , <br /> � <br /> 1 <br /> } C�I�U � --- <br /> ./ � � �� �'`�• •�-C Addres: <br /> .)�r J� . <br /> ' ' .�(�' W c-/1....r]-K--G,�`•.f... <br /> ielepf�onc Number <br /> .J'/�� (/'7 /��/ Dale -- <br /> �-Y[��YLi '\?e�-ccdllts. <br /> IMpedor�i ignafure r $ <br /> Fee <br /> Dafe <br /> DEPT. APPROVALS <br /> Remarks Engineers�,,.�'�� r �'•�e�-'C�n^ti- <br /> �Nater ��_�� <br /> Strcet <br /> Communicalions - '��' <br /> Tra!fic <br /> Planning <br /> � � <br /> � N ,r 1�=� ti� � <br />