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EVERETT, WASH. <br />i <br />The Undersigned %"�-� <br />Hereby applies for permission <br />At the following <br />SKETCH <br />(Work to be donel <br />The undersigned owner hereby agrees to hold and save harmless ihe City of <br />EvcreR lrom any and all doims for domages thal may arise becouse o! ihc <br />inslallotion and mainlenance of the imprcvemenl hereto applied for and <br />furlher agrees lo remove some upon notice from the City and to n�place oll <br />public properly damaged Ihereby. <br />�/ <br />', , ��,� -- ._':.,...:..).i ;, <br />In:pecbr's.5ign�ture r-� - <br />r .� �' . <br />•r <br />Dal <br />I <br />� �, - _ <br />�• F.;. .. L :'/�' <br />_ . _ ._ APProved By _—__ _ — <br />�� •. q i� '�,��- � �l � �t _ <br />Date Approved <br />'�:-;.' i��+,- �"i. �, <br />_ <br />'� <br />Lc"•i <br />_ -.--- / <br />Variance Required <br />Ycs . ... ... . _.. <br />No <br />� <br />/ <br />� <br />Signalurc ol Applimnl� <br />i <br />i � <br />� � /� Address <br />i, <br />, , %' . <br />Telephone Number <br />Dale <br />Fce <br />DEPT. APPROVALS <br />Engineers � � � �-�' ��� ��'� — <br />i <br />Waler <br />Slrect � . - a�L- ;. /, . T Ll. <br />Communicalions � <br />/S1 `�` <br />Traffic - <br />Flanninq ��� <br />