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�ITY �Nvl!�EERS <br />EVERETT, WASH. <br />� .�� � <br />The Undersigned � /' ' <br />., � . i s l . ir: � i � , i � . / - <br />� � ! -./:�i:�% ' � r:*' ,. , • <br />Hereby applies for permission to— ' � � i <br />, <br />� <br />r, - <br />At the {ollowing location ' " � . <br />. _._ __, ,....:� <br />SKETCH <br />IWork tolbe donel <br />I � <br />'� , <br />Q <br />� <br />� <br />% � <br />I, 1 <br />il <br />13 <br />�— BY - <br />�5�ti - 1�'. I�(c�� <br />Dale Approved <br />* NOT� <br />CHFr <br />p��ul�. . � . ,. .. <br />LOCATIONS t�tFu!,� ' - ' <br />PROVIDE FOP. �` <br />i�RQr'��R i)RP.!� �',G <br />�17 � <br />,4soUAL_r OR�vE. <br />sr,�E�T <br />TFm undersigned owncr herchy agrces lo hold and save harmless the Cily oi <br />Evcretl Irom aoy and oll doims lor da�nages Ihal may o��se becouze of ihe <br />in;lallolion and maiMenoncc of ihe improvemenl hcrelo applicd for and <br />furthi: agrees lo remove sam^ upon nolice irom Ihe Ci�y and �o reploce all <br />puk;lic p��ncity domac�ed Ih.reby. <br />. . �__ 1 i <br />, %,�-- % <br />a ,-� �— <br />Inspecfo�S SignaWre <br />� �x�y <br />Dofe � <br />Varioncc Hcquircd <br />Ycs <br />Nc <br />� Signolurc ol Applicanl <br />Address <br />ielephone Numbrr <br />Dafe <br />� <br />s g� — <br />Fee <br />DEPT. APPROVALS <br />i� <br />,� `r..� , <br />Engineers ��—=:a�-.� r_� <br />Walcr�,7�- <br />Street -.� � }' ' _ <br />Communications _' <br />-i,,;::. .... .. __ _—__._--_ - <br />