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Fie,eby applies for permission �o � <br />- - � <br />Af ihe following locafion �, In/. �-' ' ``=-� — �- - _ " '4 ;'�c '�r-yr'/ '-,;%.' . <br />SKETCH <br />(Work to bc donel <br />srR��r <br />_---- . .__ _�... <br />The undersigned owncn c�reby aarces to hol8 and save harmless the Cily o( <br />Everetl from any and all claims fo� damages that may arise because of Ihe <br />installalion and maintenancc of Ihe improvement herelo applied (or and <br />}urther ogrce� to remove same upon nolice (rom �hc City and to mplccc oll <br />public properly damaged Ihcreby. <br />. <br />� �i (��`__�.1.'��(� <br />'�>�Z%/�C' i�"Z.. , r �� .';�' , � , <br />(�,�,J���;.. �. I <br />9 <br />Inspecfor's Signafure <br />� i i.—� G',s��ci�E.� `='i/i��' <br />Dale <br />, � ._'�:. .'� .� - <br />Fnginc <br />Water <br />Strccl <br />Comm <br />Traf(i[ <br />Planning <br />. -, i <br />F <br />� c.r �; 7-��.-/ <br />.� v�l � � �C <br />�/�'c=�f1' <br />S:_A�� i'��0� <br />Variance Required <br />Yes _. _ . _._. <br />No.. . . . _ . ..... _ <br />: , <br />Signolure al�Applitonf <br />�. �� � i. � . J . . <br />Address <br />�-�' `' 1 <br />Telephone Number <br />� C. <br />Dafe <br />5'`.l y-..�' w N i L\ ��. ��: F <br />L � <br />Fce <br />!� ,-� ..-T,��i <br />