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EVERETT, WASH. Approved By
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<br /> The Undersigned � F'`�-� � t� �� '�--'� �'� �'�• �-' ��>� ��- L-- > __ Date Apprcved
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<br /> Hereby applies for permission io � 1`b S 1"A �. 1 A �5 U ' I -> �� ��:i� � :� �' :^./F�,'�/
<br /> At the following location � � 2 �^ � � � �'� � ���
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<br /> The unuersignW ownen c�reby agrees lo hold and save harmless fhe City of Variancc Required
<br /> Everett from any and all daims for domaqes Ihut may arisc because af Ihe Yes _ . __..
<br /> insfaliation and mainlenonce of Ihe improvemeN hcMo applicd for and No. .....�.........
<br /> {urfher agrees to remove same upon notice from Ihe Cily and to reploce oll � -�-��
<br /> public property damaged �hereby. � ��� " ' '� � '
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<br /> � { Signafwe ol Applicanl
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<br /> ,� �� � C l��' ('(1�'4-"'/"� � � Telephone Number
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<br /> 1 Datr
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<br /> Inspecfor's Signalure I�� ��L�, $ 7, J lQ �j � � - Zb--��-
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<br /> Fee
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<br /> UEPT. APPROVALS
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<br /> Remorks Engineers, �� � ��/<�� ~ - � � =�
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