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CIP'( ENGINEER� <br />EVERETT, WASH. <br />The Undersigned <br />�T �niA�n�� rwA�; _ <br />Approved By <br />�me <br />. � <br />Her�;by applies for permission to 1�AV '= Pi L L E�C' f� � v% T� /��" PR O�� ��`�'� \� ����t <br />.Y-\ ` P } —'r�. <br />At fhe following location ��� J ��=C �L �, it Y'j V L� <br />SKETCH � -�'17N �=T _ <br />IWork to be donel �!� <br />�P ;AL�� 'To tr3E <br />f�i..v�n — <br />- :\ <br />( CATCN BASi�J <br />REOU/r'�EO , �� <br />I � �— ; <br />w� � Z <br />� � r>> <br />��_� <br />i I � i* <br />y -- - <br />W � = <br />� <br />� <br />� <br />The unde�signed ownen c�reby agrees to hold and save harmles: ihe Cily of <br />F_vereB from ony and oll cloims ior domages thal may arise because ol Ihe <br />installation and moinlenance of fhe improvement hereto applied (or and <br />(uriher agrees lo renove same upon natice from the Cily ond b replace all <br />oublic oroaer�v damaaed thereby. <br />Inspecfor's Signal�re <br />�y. <br />S/Tr c f�F-%t��� -'�-'%i-��S <br />oare <br />�,�,��.,//�� �/�-�/��� <br />si- �. ,,� . <br />;; �i ,.: /-� <br />- �, ' � � ,c.� <br />� .�! � <br />� <br />c - . . <br />0 <br />.� r . , �. . . � 1 <br />.: � b�t;,��� <br />started. <br />Il�'i L <br />CHECK WITH N41TER <br />PL fOR WAl'ER LI�E <br />^r,rr,.^,��; g�FOR[ EXCAVATION <br />;00 <br />No-� E : <br />S�CE L.e I. D, <br />Cao 1 �-�r�- <br />�srAA�i�� �r :� <br />�, i��ND� <br />Variancc Required <br />Yes <br />No <br />`�-���� %f %�c��,�.� -- <br />Signolure of Appliconf <br />�( .%�L�O S� �.LLJ'a� 11/t� <br />add,e�� <br />,� A� � - ,S' � � � <br />Tclephone Number <br />� (:-C ..1 �� � � <' J � <br />Dale <br />s No r�.E <br />����1�� � � Fee <br />,�,,�'f,v ;o-;i-73 <br />DEPT. APPROVALS <br />Engineers - �� <br />Walcr �� '���, . �`� <br />a <br />;� Strect " <br />Communications �� <br />Tralfic <br />Planning _ � <br />' (�`\�rL�� V�\f\il�i..• <br />� � _. _z_.. . ' <br />..�a ,m,. <br />