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EVERETT, WASH. <br />The Undersigned —�7 <br />t <br />Hereb, applies f r permission to— <br />y1 <br />Approved By <br />t�l.�Iri Fla I, \`L I,,cl <br />4 Dale Approved <br />7 <br />At the following location- <br />'•ANC-`(i�R2t�CiiTY.h9N�{iJ�4' <br />SKETCH _ <br />(Work to be done) - 0 <br />PROVIDE FOR <br />PRO, <br />CHECK WITH WATER <br />DEPT. FOG ke 1 ER LINE <br />LOCATIONS DEFORE EXCAVATI <br />A/ / /=v <br />.i <br />n, <br />a <br />dN <br />fn <br />' <br />Is <br />Of f/1 C_ <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 same upon notice from the City and to replace all <br />public property damaged thereby. <br />l <br />Inspector's Siffn-ature <br />-- <br />Date <br />A 1/E/VI-� <br />Variance Required <br />Yes <br />No <br />h� <br />Signature of Applicant <br />Address <br />Telephone Number <br />Dale <br />0>� <br />t ,t <br />D Fee <br />DEPT. APPROVALS <br />Engineers <br />Water ' <br />�— <br />Street <br />_ <br />Communications <br />Traffic _ <br />Planning <br />