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The Undersigned <br />Approved By <br />AY/Z <br />Dale Approved <br />Hereby applies for permission to I NJS-,4_Lj-_C; p y q i r,J Lt K1 1<_ <br />tl=IQCr nN \ <br />At the following location <br />SKETCH — — — -- - <br />(Work to be done) <br />The undersigned owner hereby agrees to hold and 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 some upon notice from the City and to replace all <br />public property damaged thereby. <br />e <br />Inspector's Signature <br />Dale <br />AV r=. <br />_St O� W qLK <br />I <br />i VY` J�,yY <br />", <br />Variance Required <br />Yes _.. <br />No ..... <br />crow nl <br />I Signature of Applicant J <br />Address <br />�...-)," <br />Telephone Number <br />-I Date <br />�— <br />Fee <br />Water <br />Street <br />Planning <br />MW <br />