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rVERETT, WASH. A oved By
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<br /> ' � `, � �� , ^, . J Dat' Approved
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<br /> Hereby applies for permission to ' ,
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<br /> At the fq�lnviing location ��-�' i J% • � �� �'Gi/1�r`' � r �' 1_,_ '� �— ��-�✓ ��,
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<br /> SKETCH I %� �
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<br /> The undersigned owner hereby agrees to hold and save harmless ihe Cily of Variance R�quired
<br /> EvereM from any nnd all daims for damages Ihat may arisc because o! IF.e '�es . .... . . . . .._..
<br /> insfallation and mainlenance of the improvement hcreto applied for and No.. . _ . . . . ...
<br /> (urthr.r agrees to remove same upon nolice irom fhe City and to replace all
<br /> public property damaged ihereby.
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<br /> �/'��� . /Ii l.�lc' : � .-�'Ei'.
<br /> . . � .-CG^,��'` . - � Signalure o( App�im f
<br /> � � T,PEET ✓c - ; . h'�_ ,_ ._ . _
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<br /> J'✓ c�iST :�/r'F OF G,( U ,r���, y' - .- .. ._ _. � �' .. :+�'' 1-�".-�-
<br /> ._ �� ��� T ., F A..�:,' �i� - . . �r'C-� / �;'l,i%' � %..'J Address
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<br /> �� Telephone Number
<br /> NUTE: CHECK WITH WATER DEPARTMENT
<br /> FUH �NATER LINE LGCATIONS
<br /> �� BEFORE EXCAVATIUNS Da�e
<br /> �
<br /> "1,=-t-.`�� �'• �5��-•.<�-�c.�
<br /> Inspetl�Signafure �� 5
<br /> Fee
<br /> �1,s � 9
<br /> Dafe
<br /> DEPT. APPROVALS
<br /> Remarks Engincers
<br /> � �
<br /> `.. Waler ''
<br /> � Strect� / ;�, �. , i �
<br /> Communim�/ti�o'�' .�' � �
<br /> Tralfic,_.�.J ��'r'l�c � .
<br /> Planning ��.• r' .
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