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EVERETT, WASH. roved By <br />_tTulu �3 1gCoq <br />— 4 Dote Approved <br />The Undersigned <br />Hereby applies for permission to <br />At the following <br />SKETCH <br />(Work to be done) <br />The unders.gncd owner hereby agrees 'o hold and save harmless the City of <br />Fverert fror. any and all claims for damages that may arise because of If•e <br />installation and maintenance of the improvement hereto cpplied for and <br />furt'ier agrees to remove some upon notice from the City and to replace all <br />public property damaged thereby. <br />Inspector's Sig re <br />7/Z / 9 <br />Dafe <br />Ij T5R�ORIV�=A.Y <br />NOTE <br />Cf+LCK WITH WATFR <br />pF-,-. 'J-tZ LINE <br />t C: B,R RE EXCAVATION <br />I I Fh�O\"i'C FOR I <br />Variance Required <br />Yes _ <br />No <br />,'v s <br />� v <br />Si9ficsture of Applicard <br />�w a7 bJ15-Ji ///zet/ D,4? <br />Address <br />Telephone Number <br />Dole v r <br />Fee <br />L-1I77S� <br />DEPT. APPROVALS <br />Engineers --- <br />Water 0. . *J . i / /, t <br />Street <br />I <br />Communications <br />Traffic <br />Planning <br />