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EVEREIT, WASH. Approved sy
<br /> %� � I�/ � � �. ' � � -`.� : �_ �i '.��/✓ Dore Approved _.
<br /> The Undcrsigned " ' ,1��, ,
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<br /> Hereby applies for permission to
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<br /> The undcrsigned owner hereby agrces io hold and savc hormless 1he Ci1y o1 Variance Required
<br /> Everett from any and all daims lor damages Ihat may misc bemuse uf thc Yes _ ._....._ ._. ._...
<br /> inslallation and maintenance of •he improvement hereto opplied lor and No . . . . ._. ._.
<br /> lur�her agreet to remove same upon notice }rom the Cily m�d lo teplace all
<br /> public property domaged �hereby.
<br /> � �� '!✓��.�� '!a..c� '
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<br /> .., ,/ � SignaWre oF Applicont
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<br /> /Vi"r`//.r //,. ',yiN /•'/:!�` !iN/I�./, Addrecs �
<br /> l�/'!:'," Kiy�-t .�- Y" i"= �� — / �LJ' J
<br /> ielephone Numbcr
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<br /> Dafe
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<br /> lnspedor's ifgnalure , . = L- i a 7 �a
<br /> Fee
<br /> Dale
<br /> DEPT. APPROVALS
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<br /> Remarks Engineers —
<br /> Wa�er
<br /> Streei_.�
<br /> Communimtio s ' ' �L � ��'-
<br /> "Y"_--
<br /> Trofii �__
<br /> Planning —
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