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EVERETT, WASH. <br />The Undersigned <br />Hereby applies for permission <br />At the following location <br />Approved By <br />/970 <br />Date Approved <br />.E'OCKEFELL E-e A VL <br />The undersigned owner hereby agrees to hold and save hcrmless the City of <br />Everett from any and all claims for damages that may arise because of the <br />installation and maintenance of the improvement hereto applied for and <br />further agrees to remove some upon notice from the City and to replace all <br />public property damaged thereby. <br />Inspeclor's Signature <br />Date <br />Remarks <br />Variance Required <br />Yes ... <br />No _.. <br />�496 <br />' SrOEWA LIf 7�'°��I i- r �h,c9—v,1.t/✓L <br />rGueB Signature of Applicant <br />�dd=ss (T % � SO.0 ---� Address <br />MAKE C4)7 F ,Z? E Telephone Number <br />ConlF:. '�� �. iL�sTGRADE <br />Date <br />s �n <br />Fee <br />DEPT. APPROVALS <br />Engineers <br />Water !'19'7d <br />Street i44404,c <br />Planning <br />