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The Undersigned ` <br />��. <br />Hr.reby applies ior permission to <br />At the following localion_ <br />SKETCH <br />(Work to be donel <br />,:' <br />�' .°%,�'� -- <br />C���. �/�/�/ <br />The undersigned owner hereby agrees to hold ond save harmless the Cily of <br />Everett {rom any and all clair.is for damages that may arise because of Ihe <br />installation and mainlenance of Ihe improvemenl herelo applied for and <br />further agrees to remove same upon notice iiam the City and to replace all <br />public property damoged thereby. <br />�a�� - -.,� '� '� ,.--c.�.,. 1,_.. <br />Inspedor'vSignofure � <br />.�j 3 y <br />Dale � <br />� R�r;l �a��i <br />Date Approved <br />/ �, <br />n• <br />ZO ' � : _,L � . _ <br />•-- / L. <br />Variance Required <br />Yes.._ .. ....__........ <br />No_ .. ......_..... <br />�E? i G .�� f <br />Telephone Number <br />�- � -�s <br />Date <br />$ � — �r', � 7 i � <br />F�e <br />DEPi. APPROVALS <br />Enyinecrs — <br />Walc�� , �%%�Z[.r,.P — <br />Strer.t <br />Communimtions . <br />Traffic— <br />Planning <br />