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• N P.Pf'LICl�1�IUiJ FUI; IiIGIIT�Oi�-P�!\`! USC PF'FIh11T <br /> , rvrrril <br /> +� <br /> Y <br /> Z\ � � <br /> �:r�r - <br /> cn��•�riciNi:er�s • <br /> fVFRL'TT, WASIIINGTON PEFlMI'(NO. � � .7'i�l <br /> lhc UnilcrsigncA ESi"������ Q,=! Sis i,v� <br /> Hc�cbyupplics(orp��nniscionto (��2h�S7iPJCT� /Q� 2� � ,r�Sf'7-If�LT f�lii <br /> _ J — <br /> At the following location_ !�r f ' /�d�>'--,��__� <br /> SICETCH <br /> (LVork tr,bc Jonc� � � <br /> Scc i�T,��fa�o <br /> D�C � Gahs7`���J <br /> �j/�'� �2E/� <br /> � / <br /> GNrvEwAv SECT1011 The undersigned o�vner hereby agrees to hold and <br /> �FO SCALE . � save harmless the City of Everet: (rom any and all <br /> —� claims for Jam,yes that may ari:e benusc of installa• <br /> � t r' un __� tion and maintenante of the improvement hereto <br /> �30" ' � __j 30•� � applicd for anJ lurther�grpes to rcrnove samc upon <br /> �� '1� —'1 . notice from the Ciry and to replace publir,prope�ry <br /> damaged thereby, <br /> Signatuf2 r,f Appl�cant <br /> I�:OPY qF THIS/�PPLIC/�TION TO Address — <br /> I 13E f'OST[D ON JOBSITIc. . � <br /> ICALL L'NGINGERIPJG DEf 7'. 259�A811 Tclephone Number <br /> � ?a 4'Gt1H5 f3EFORF_CONSTRUCIION Date . <br /> i.: . <br /> CI IECI< LIST <br /> \'Ja;nr Valvc �'eL <br /> Diaina,_ DC�)L ��:pfOVB15 <br /> Cw62�Gutter . Enpinecrs_ � <br /> Sidew;,lk . <br /> -' � Watcr ' . <br /> ;trcet__ <br /> Irsper�ui';Siyn;ture � � . Ccmmunications <br /> Tr.A f ic <br /> Planning <br /> -Daic-'------ — - <br /> -�i,.rtn�At —____'_'__—__ '__--• <br /> i�lule: O�igin.illoCustoiner -- ______ ____ <br /> � r,.�i„� io �d�, "1. 1 �� � — ------ <br /> 1 Cupy tn In•: .r��lor APPrn��ec1 by --- <br /> . Dala:lop�oved --_'-��--- <br /> t^ <br />