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The Undersigned <br />Hereby applies for permission <br />At the following location <br />SKETCH <br />IWork to be donel <br />, , <br />;= � � ,� <br />Date Approved <br />! � �. , _ � �� ' ',i <br />f . ,� �, , . . .__ - � <br />e <br />!—��� <br />=r c, -� <br />i°= 4 0 <br />-�� � <br />/T• <br />/ <br />�� i�c.a F+o c,.s� <br />% nsPhair <br />F� D/�J <br />�c. c�k. <br />. � <br />n <br />,^�0 <br />�V�.`,. `� i� <br />The undersigned ownen c�reby agrees to hold and save harmless the Cily of <br />Evere�t from any and all claims for damages that may arise because o( the <br />insfallation and mainlenance of the improvemenl here�o applied (or ond <br />further agrees to remove some upon notice from the City and lo replace alI <br />public property damoged thereby. <br />. C'-{(7''C'..' /C-f.11_..' <br />. �/ r 3����/ � <br />/ � G' <br />Inspector's $ignalure <br />Dale <br />f!� � j <c: it� <br />-�-��C�: <br />Variancc Required <br />Ycs... . ___..._. __. <br />No . .��..___ _. <br />(/� <br />� .�''.��.L �(/ , ��,�1.�. 1, <br />Signalure ol A�licanf <br />=/� � - -n� 5�` `� 1 , � '� '�rc::(��� <br />Address <br />�C�— �a'/`> <br />ielephone Number <br />-, , ,_, _,: �. <br />Dole <br />3 I(,'" 1 /c l4'? <br />Fee <br />DEPT. APPROVALS <br />Engineer <br />Water <br />Slreel <br />+ i.i . <br />Gommunimfi0ns y� �' ' ' <br />Tmffic �1'�' �� L > /� e . GQ � • .. �• <br />Planni�:;, _ __._ __. <br />