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EVERETT, WASH. <br />�. , /.,. <br />The Undersig�ed ' ' <br />Hereby applies for permission to` <br />i 7'`.^.i' ��S.n_ ;%,�.� fv <br />� r � _. <br />At the following location '_.r„� --,�,'.^�e <br />SKETCH <br />IWork to be donel <br />EX lS T <br />� <br />. . / , . . , <br />' 1 J �= (��J �' �i <br />� i. _ <br />rmrm�t�::.:? '/ : � ' G:in. ' , <br />�� �' yQ � <br />N�ALL f'L.4/�/TS <br />, <br />, �, <br />� <br />c�'y <br />n'� <br />� <br />� <br />iivsrq�� �' %, � f�,--� <br />The undcrsigned ownen c�reby agrecs Io hold and save harmless the City of <br />Everell from any and all claims for damages Iha1 may arise because of Ihe <br />installation and maintenance of Ihe improvement hereto applied for and <br />furlhcr agrees ro removc samc upon nolice from the Ciry and lo replacc all <br />public properiy damaged thcreby. <br />i — <br />i r` � <br />i <br />Inspedor's Signalurc � <br />S� 9 �G_'I <br />Dafe <br />h <br />'w <br />v <br />� <br />rl�roved By <br />I'lC•�I "/v� ��'1,� t <br />Dale Approved <br />. ! <br />Variancc Required <br />Yes.______ _........... <br />No_. _._.._._.... <br />i :�_; l .�"r c Ei.Coz�A''. <br />Signafure of App�anf � <br />? �j �4 _ "/.- , : � �.��.�._�"��_ <br />Address <br />�E'.� � .5.: _ �,�, �`J f !�._ <br />ielephone Number <br />Fj <br />Dute <br />Fee <br />DEPT. APPROVALS <br />Engincers <br />Wafcr < .'� � i �s— /5�/•f+.fL vY <br />Strect � -�. / ;;�:;. , /-� .r�_, <br />Communicaho � � �'� � � � °� <br />Traf(ic_�1 ��-� <br />Planning ����{. <br />