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EVERETT, WASH. - - -- — qPWo�«i �y -- <br />� <br />,, <br />;% � ' - �•iil�:� 1:, �`�'��•'�( <br />The Undersigned '- ' /I � F'- ✓ f 7��� `� Dale Approved <br />Hereby applies for permission to ' �"'% � � "`�'' ' � f / G � � r�' ��{�- <br />At the following location <br />SKETCH <br />IWork to be donel <br />� 'T .,.; <br />. - � <br />iVoT� : �—�L_ <br />,C3d,�f�,�GG� �: TO BE <br />/S i �ND �/= /_S�f' A <br />�-, �r� -� ��, f i�Uk/:_ ''�� ,! , <br />� ,' .�� V;� <br />SGA�E � '• ?_O.� <br />lx%� � --�' - <br />a L�� <br />�a �� t <br />i J�-L <br />` �/� Q /" �% ��./ � � `:�- /`'� , 4- _:� <br />i�r'l✓[. �' /U � ll. `� '. . <br />{''✓/�= � <br />The undersigned owncn c�reby agrecs to hold and save harmless Ihe Cily of <br />Everett fiom any and oll claims for domage� that may arise because of the <br />insfallation and maintenonce oI Ihc improvement hereto applied for ond <br />furfher ogrees ro remove same upon notice from Ihe Cily and to replace oll <br />public properly damaged Ihereby. <br />/`:e i� ->�%r:s. - .�.. �- <br />�' <br />Inspedor's Signafwe <br />Dofe <br />d' <br />� <br />\ <br />L� ir'r S <br />� Tp _F <br />Variance Required <br />Yes_.._ ....__...__._... <br />No____......__.......... <br />i ��..-L- -i. - r7r <br />�' Signafyre ol Apphcanf . <br />C'�:� `�l• I "i t - �� ,�r �. <br />j �i� 4 l � �1- -` � �� <br />l �. ��i`£ �,� ,.,,..,�.. <br />J:i �C: " - .S .% I S. <br />Telephone Number <br />Walcr <br />Slreet. <br />Traffit_ <br />Planning <br />; " l� :� ' -: • /'.i J ✓� �1 . �; '- � <br />, !���' ., �-Dale <br />$ <br />Fee <br />DEPT. APPROVALS_, , <br />�i ' � , <br />ri,=1_���<< ��. L�a�C� _ i— <br />