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EVERETT, WASH. <br />By <br />1 �,_1G.'f '✓ /r T Dote Approved <br />The Undersigned <br />Hereby applies for permission 'o �a� <br />At the following location `5 E t%/cam <br />SKETCH <br />(Work to be done) <br />The undersigned owner hereby agrees to hold and save harmless the City of <br />Everett from any and all claims for damages that may arise because of the <br />installation and maintenance of the improvement hereto applied for and <br />further agrees to remove some upon notice from the City and to replace all <br />public property damaged thereby. <br />4/161-767 <br />Inspector's Signature <br />Date <br />1RECEIVET, <br />APR <br />LN91Yr St1P rlfll(Ifi1Fnt L 00 <br />Variance Required <br />Yes........_ _. ............ <br />No..... .....___._...... .. <br />!' <br />Signature of Applicant <br />! if iE, F *Address <br />?- , 5 i <br />Telephone Number <br />/. 1970 <br />Date <br />s <br />Fee <br />DEPT. APPROVALS <br />Engineer C / <br />Water <br />Street <br />t <br />Communications <br />Planning <br />