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UIY tNGINttKS �,1 �.,..� <br />[VERETT. WASH. �ovecl By <br />The Undersigned <br />:�� "'�-�//' i'G-7 ,; . <br />'✓� '�� �i' � <br />�e� ber =i 1�t(„`� <br />Dale Approved <br />� �T <br />Hereby applies for permission fo G��� �� �� r''i��� G• _���; _� _ <br />At the following location /� <br />SKETCH <br />IWork to be donel <br />�� '�i l !��i"" <br />The undersigned owner hereby agrees to hold and sove harm�ess the City of <br />Everetf (rom any and all claims for damages that may nrise because of the <br />inztallation and mainfenance of ihe improvement hereto applied for and <br />further agrees lo remove same upon nolice from the City and lo replace all <br />public properly damaged thcreby. <br />j�i-i:��f',. �G�7/7ti <br />/ <br />:�'�\ <br />� <br />..��.n..���.� J7r-.....1 �.._-� <br />Inspecfo'r's Signolure <br />lZ;�i��, � <br />Dafe <br />Variance Required <br />Yet__._....__.. __..... <br />No__._ ._.. _. ..__.... <br />� . � j ' <br />{ -, . ; �"� -:1 .'� � t. 7J c!' <br />Signature o( Applicanf <br />���'�f - �'�r?'.ti�E,C'.. <br />;� � <br />_j� '.,,� �!?i C' ij::�::_ <br />add«�� <br />,:;� � .�:>-. ' <br />Telephone Number <br />- � - ,� � <br />,.� r <br />Date <br />g � " <br />/ n � ;;�r Nc , <br />Fee � � � � <br />L - /?L/`)Ly � <br />DEPT. APPROVALS <br />Enginecrs ��'��^� � V� ���"^- <br />Watcr l' ���!`X�� .'t-�„�. <br />Slrcet <br />Communications � � � ! �� ! <br />Traffic— <br />Planninc� <br />�' <br />