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�+ :� n�u ��� °1.IC:1"t 10N POR (iIGH f�01=�1,:'/\Y IJSI: P[1;1111' <br /> � ,.�.. <br /> � <br /> , t�', .� <br /> i �:c^.y <br /> � CIIY t;iVGIN�FRS ' <br /> EVERf:TI'. CJASIiINGTON � /.' <br /> PERfd1T MO._ �_ ' ,____ <br /> Thc IJndersi9ned i; i_.._�a� �r - f-N7��; � %-, ,�,_ , �� ,_ ' <br /> i <br /> I� hlerchy applies fnr permission to ��n�JsT�,'v^-- _,Q 7,-; f}Sr'r;� � /�l� <br /> 7 - <br /> At the follcvnng locatibn •;'-�7 / r=✓ F'r_� .'" <br /> SKETCH --�- -- - - -- <br /> (Work to he done) � <br /> �. . F��; i?, . , ' . <br /> G7K �"L� i'DJ�S�7L/�'G�-G�7' . <br /> �-�'`� '�/7� <br /> CRIVE'.4AY SECTION The undcrsign[d o�v;,cr hereby agrees to hold and <br /> NO SCnlfl save harmless the C ;y of Everett from ,ny ,u d all <br /> � � �� claims fnr Jama9es that may ari:e 6ecause af insWila� <br /> 11' LIP ' [ion anJ main[enance of ;he im��rovement hcrero <br /> I_sp• � __�- _ __� ,.pplied for and (url' er agree; to remove same upm <br /> � nolice from Ihe City and to replace public prooerry <br /> damaged ihrreby. <br /> Sii�nature �f Appiicant ' <br /> �QP'I qF "lfIIS nlPLICNICPI TO AJdress <br /> k3G I'Oz�fL=D U^J JOGSII"L-. <br /> CALL ENGiN[ERING DfPT. 759�9817 Tclephore Number <br /> 2�1 FiOURg pEFORF COWSTRUCTION Date — <br /> CIiECK LIST Fec —' <br /> Wat�r Valve � <br /> Dnma�e Dept. Approvals <br /> Curb Y� Gulter Gngincer5____ <br /> Sidewa;k — <br /> — Nloter_ <br /> Street <br /> — Communications_ <br /> Ins�,rc;oi'sb',�gneC�re — . <br /> • T�af(ir. <br /> Planning <br /> -Data--- --- <br /> Remarks -- - ---- -- - — <br /> Motc: Oriqia:d lo Custuinar - �-- <br /> i c�.,,•, c� r�i� 1 � � c --- -- -- ._.._... <br /> : <br /> � 1 Cr.py to In;pr.,:tci . .1. (. •" Approved uy . <br /> I ----- --_'-_----- <br /> , ' .L�:. A,���� �,c,. . ___'___'._"_._..— <br /> -r <br />