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' • — /�i'I'LIC.nTIOiJ FOH HIGIII" OI- CJ�\Y USf P[HPd1T <br /> cvrrrll <br /> r"�.�:1 <br /> ' . �,,.;v <br /> C1T1' 6NGIWCGRS <br /> i:V[Ilt:l���, l�'ASFiINGTON PFR��nrNo. 78 _(`I .� <br /> Thc UndcrsigneJ__ ��!'��:_ 7��i•'�fJi�^/.� ___ ,__ _ — � <br /> r <br /> hlcreby al`Plics lor pcimission ro _t ^ '�7 iC'J;:.;' r 7 � �.^! � =;'C��^� ll�..c/ "_ I <br /> At thc falluwm9 tocation ':ir) V.� v�� !7a' " _ _� _` I� <br /> SIiFTCH <br /> (1;otk t0 6e Anne� ' , <br /> .`�G f r�i %!�a�/j��/� <br /> %�'�� <br /> i <br /> � - <br /> . �_— <br /> DarvEwnr SEdTION The undersignrd ownen c�reby a9iees ro hold and <br /> rv0 SC4LE save harmless dic City of Everett from any and all <br /> �---- � � ciaims lor d,mages that may arise because o(installa� <br /> �f' LIP tion and maintenancc of the improvement bereto <br /> ---� applied for and further agrecs to remove same upon <br /> �30" Iy_-�_____�I 30" I noticc trom ihc City anJ to repiacc public property <br /> 1' 'I <br /> . damayed thereby, <br /> 9ignature ol Applicant <br /> �CnPY Of 71115 nPPLICAiION TO Address <br /> I OE POSTLU ON JOASIT[. <br /> Telephone Numbcr <br /> CALI E�JGIVECRING DEPT. 259�t3911 <br /> � 'J HCURS D[FORG CONSTRUCT�ON Datc �� <br /> �.-----�—--�------- <br /> � CtiECK LIST Fec <br /> �'J�iar varoc Dept. Approvals <br /> . Dr.iina9c <br /> Cuil� R Guncr ' Enginer.rs_. _ <br /> SidewalM-- <br /> _ _ V:ater <br /> Suect <br /> --- - <br /> . r,rmn,unications--- -- <br /> In:�,cclui's Si;ndiwe. ____ ... " .-_ __ _ �!'�af(ir__ <br /> Planning'___.' — <br /> n.��„- - - - --__ _ -- - <br /> -- — - ------ ------ <br /> Hem.uks _ ._ ._._"__ _'._--'_—_ <br /> �'otc: O�iqin:J to C�i:tr,mcr —'--___.______.,_ <br /> 1 CePy to Pde '� C11� ' —"___.—.. .____.__ ___._—.. <br /> 1 l'c.py t�� In�per,ior '- -L �� J .1 Approvc,l I�y . <br /> C�aia APPn�;,.�1 __.__."__'___ '_____ <br /> -�.. <br />