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<br /> EVERETT, WASIi. �% Approved By� .
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<br /> The Undersigned �`� ' �l � cy �1+ " �'� Q ti� � �� �� Datc Approved
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<br /> Hereby applies for permission to � �� � 'f= . N i c F ' f�.�
<br /> At Ihe following bcalion �y � � � �-� �n I �
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<br /> IWork to be donel '
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<br /> The undersigned owncn c�reby ogrces to hold and sove hormless Ihc Cily of Variancc Required
<br /> Everelt fmm any and all claims for damages Ihat may arise bemuse of Ihe Ycs . . __..
<br /> inslallatior. and maintenance of thc improvemenl hcrelo applied fcr and No
<br /> (urther agreet lo remove same upon nolice f�om the City and b replace all
<br /> public property damaged Ihereby.
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<br /> ' Signalure o( Applicant �
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<br /> ��''��jj Addrets /
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<br /> y�y F ��y __V` � ieiephone Number
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<br /> � Dafe
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<br /> Inspedor's SignaWrc $ l� — ]�9 t� �lll���%1 ..�.��
<br /> `. � / 12� 0%A� Fee
<br /> �J-�C�- L�(, � �- / � � �/
<br /> Dale
<br /> DEPT. APPROVALS
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<br /> Remarks Engincc�s� -7'C'�'�w �`+�",. ' �`- :
<br /> Walcr i� .��,��u<==; 'I- I • �/
<br /> _ Strec1��� � � �`
<br /> Communimljonf ��'�' =� �'��•-
<br /> Trnffic -� ' O�� 7 � 7i
<br /> Plannin� '��'l'�
<br /> �all En�ineering Depf. 259�A803 �'ROVIDE FOR
<br /> �, PROFER DRAfNAGE � �OT�
<br /> 1 HoutS be(ore CHECf( Prn�� �'/aTER
<br /> c:n:fruction is started. ;�:: �r. ���r. �•;�:�,,�_F; t_itdt-
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