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EVERETT. WASH. <br />The Undersigned <br />Hereby applies for permission <br />Approved By <br />Dale Approved <br />_ �/ -� ._... , <br />At ifre following locaticn 7 �� �- - - - - ���} f 1 f � �"�'�i �- - "�"''� � f'r'� : '` "��`� <br />SKETCH <br />-- IWork to be done) <br />—� <br />l._-- --- <br />/� q s 5 _, �.� <br />� <br />� r�'".. <br />�YIGt� <br />—' r � t�. l, — kc� b��i <br />Allet� <br />_ __ - ------_ - - ----- <br />I <br />The undersigned owner hereby agrecs Io hold and savc harmless the Cily of <br />Evereft from any and all claims for damages that may arise because o( Ihe <br />installalion and maintenance of the improvement herelo opplied for ond <br />further agrees to remove same upon notice from Ihe City and lo replace all <br />�ublic property damaged fhereby. <br />1! 4 V+p�Y—�— <br />fntv-;-scacr) <br />�� <br />. =� r <br />4li�i_ � <br />In:pedor's Signafure <br />Dafe <br />Remarks <br />�a�� Engineering Dept. 259•8�tl� <br />ZQ Hours beiore <br />censlruction is started. <br />\ t <br />\ <br />}'��' �.�� <br />, �f �s <br />PrtiOVID[ FOR <br />F���PLR DRAINAGE <br />�� <br />1 "� �Slc.� � <br />t�oT�' p2Yl�NAGE W/�-/ 3� <br />„_� OiIJ P21 Vi�TE PR�P�P�/� <br />Variance Required <br />Ycs_ <br />No <br />�%n�,�<.�>,/1F �z�_ <br />S�nalure oF Applicant <br />�C?.3()S �� � �I ,U(I�uSdi%�� <br />Address <br />��-9- �s3 a <br />ielephone Number <br />�r -e�- 7/ <br />Dale <br />s A1 n fc � <br />Fee <br />DEP7. APPROVALS <br />Enginecrs <br />Walcr �k" I �" i� ti,i �:. ; r�i I J_�I <br />Slrect=��.c ��L . !._� - _ � ,' I <br />ni� .. <br />Communimlions.�'%� /''� ��� � � ��'� -- <br />TraHic �� -�'.•:' . '� �?o�7i <br />Planning _ !'.'�r- <br />' P�10TE <br />CHECK WITH WATER <br />Li::P7. FOR WATFR LINE <br />"�`:'."^"'� [:i F(�Rf f:XCAVATION <br />