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EVERETT, WASH. � Approved Py <br />, Fr.', i2 ry�z � c y/4"�',�i <br />The Undersigned��.C<-�L- ��� 1� Datc Approved <br />Hereby applies for permission 10 �' �` �Sr �� _��L(� <br />At the following locafion�� z— �+�� %�l���� R �- V��. <br />SKF.TCH <br />IV��ork to be done) <br />2 <br />a <br />3- <br />� <br />0 <br />UK! �r�' U <br />Thc undersigned owner hereby agrees lo hold and savc harmless the City of <br />Everell from any and all claims for damages that may arise because o( the <br />installation and maintenance of the improvement herelo appli-:d for and <br />further agrees to remove same upon notice from the City and fo replace all <br />public property damaged fhereby. <br />N°TE: /0�%S DUE- oN PE2MiT �3b97 <br />ae�Fo�E n��s PEpn1T �S �ss�Eo, <br />�, <br />7y��� �. k � . <br />InspeUor's Signalure <br />. S7T�' �.�/�'ic�r"� ��fj �?�— <br />Dal e <br />i3 .0 V D. <br />8" q .c. <br />� <br />�. r7 � <br />�e � <br />; ;:; � � <br />_�� '�_, <br />N4 s�N�r <br />Variance Required <br />Yes._.. _....__._........ <br />No. _......._.. ___.... <br />� � � <br />;,ignature oF Applicanf <br />,�� <-. <br />>;, <br />Address <br />% �/ i - j�;/.: <br />ielephone Num6er <br />�"_ zL/ %� <br />Dale <br />5 %O � ,� .f �� �-�C <br />l <br />Fee <br />DEPT. APPROV L <br />7 �f `�/ � <br />Enginccrs` ^J, t� l �.� <br />Woter ,j.:,,.ti.- -r 1 ' ?-L� / Z_ <br />Slrcet ""�"'��`~—""� <br />' =���=��'c..,... ;,�— --�-- <br />Commonimfions_�� ` <br />TmHic -^/, . c. � _. ;� /-" - _ -_ <br />Planning �'i f�.S � /- >l-7Z-. <br />�,:•II �:.. <br />; :'� .. . . ,c 1 <br />, ., <br />� .� <br />.� <br />