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�� <br />EVERETi. `NASti. <br />Appreved 6y <br />The Undersigned �-' l'' __ Ua�e Approved _ <br />Hereby opplies for pe�.nission to � � =' �' '- % • � � � - <br />At the follow�ng lomtion S� �' "' -' " ' ' _ ' — <br />.�...;.w,.b--.........,.. _._.-^-=.a�-+�. <br />SKETCH <br />IWork to be donel _ � � ._�_ <br />_ � -- <br />� —.�=-�---��- <br />� ��'�O� <br />�C:/VC. � _i:r'i ✓C Rc <br />--- -. — � 32 2 . � . - -- -- <br />� <br />.. � I�i <br />,.- .� / �%, / �`I <br />The undersigned owner hereby agrees lo hold and savc hormless �he City of <br />Everett (rom ony and all clairt s lor damages that may arise because o( the <br />insfallation and mointenance of ihc improvement hereto opplicd for anc <br />(uriher agrees to remove somc upon notice from Ihe Cit� on�' to replace all <br />public properly domaged thereby. <br />,_ ,�. � � ,; - <br />. � � , ...t�..- � i , r i. <br />t <br />Inspedor's $igna�ure <br />/ i . - >> <br />Dale <br />Eemarks <br />�� <br />� <br />�'•. .% I`. <br />'-- ' L. <br />Variancc Required <br />Ycs .. ._ _._.._. .. _. <br />No. .... _.._.... <br />'� i <br />.�. � � (' J <br />- \_,_ y_i �� \ �_ 1��y.. �r f� <br />!Y; Signafure of ApplimnY <br />� <br />�,� % . ) �� S O.: ,., �"� /�I � P <br />Address <br />3 � � C " ) � C.• <br />�� <br />Tefephone Number <br />Dale <br />_ $ �.r/a� �`%. <br />Fee <br />DEPT. APPROVALS <br />Engineers <br />-� U�� <br />Vlaler �U� t_ .�''� <br />Slrcet <br />Communimlions -- � �' i �% � <br />Traffic <br />Planning <br />� r <br />0 <br />