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EVERETT, WASH. <br />By <br />The Undersigned-7: <br />Hereby upplies for permission to a <br />At the following location — <br />SKETCH <br />(Work to be done) <br />N <br />C <br />2 <br />�<� <br />EA <br />_ i�nrt I 1 6, �g(-.q <br />Dates Approved <br />7-0 <br />17Y-CEEZ)) <br />,�E,�Y. .� ' Ar�4�T (,E'Dce TD ,ea c•C� <br />C47-cL <br />The undersigned owner hereby agrees to hold and save harmless the City of <br />Everett from any and all claims for damages that may arise because of the <br />installation and maintenance of the imprevement hereto applied for and <br />further agrees to remove some upon notice from the City oral to replace all <br />public property damaged thereby. <br />J <br />Inspector's gnature <br />dte <br />Variance Required <br />Yes <br />No <br />Signature of Appticont <br />Address <br />r�1 L - 9- 3 w;;`'7 <br />Telephone Number <br />Date <br />$ 4L . ELL <br />Fee <br />DEPT. APPROVALS <br />Wa er <br />r A: <br />Strec' — <br />Communituii`ns�' <br />Traffic -- <br />Planning i'HI? -- — <br />