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EVERETT, WASH. <br />; , ,_ <br />The Undersigned__ �/4 i-1 �E'"i>�.� � r-��11,t_ <br />Hereby applies for permission fo <br />/ <br />At the following bmtion �.� �� ��'�/` t t.-�c.-� GL�fi`C <br />SKETCH <br />IWork to be donel <br />GCi/�1C . Oe 1 ��: <br />� <br />J <br />< <br />W <br />Q <br />m <br />N <br />�I <br />22 <br />N��:� /.,,. ._-a�.ic, <br />C." : � �. ,= rT- <br />.5r -.. <br />The undcrsigned owncr hereby agrees to hold and savc harmless Ihc City of <br />Everelt (rom any ond oll claims for damages �ha� may orise because of Ihe <br />insfallafion and maintenance o( Ihc improvemenl herefo applicd for ond <br />furihe, agrees lo remove same upan nolice fror� 1he Ciiy anrl to replace all <br />public property damaged thcreby. <br />�~ _L7RlVEWAY,. ScCI-i;. W.__; '— <br />� � �__g� <br />._.._.. go ._.... __-.__ ..� ,�` Y,��.:.� <br />� � <br />Inspecfor's $ignalure <br />�/rE G:�cc: ,rr�.c; d/,��> <br />Date <br />23 <br />,5 T <br />'34:) f <br />' �_..__.—.._.,iiti\'.I<<.�::;. . tiEC;":(ii� '_.._—. . _.. <br />r ` tRID.-:-SCAiE) <br />�� 1 <br />M N <br />� L. ".� _� <br />2�/ _ ,�,/ <br />� - � Appruved By <br />c�v.r��. .26��71� <br />Dole Approved <br />Variance Required <br />Yes <br />No <br />i <br />1._���/�'r ' ', � ' i�) �-i � <br />Signalure ol Applicanf <br />:��;5 / - � _ - <br />naa.ett <br />r <br />; - � ''- '� � <br />� Telephone NumbQr <br />I <br />� //� ; �i ,� <br />Dafe <br />� //, s° A-,��/S <br />Fee <br />DEPT. APPROVALS <br />��'����� �, �6 <br />� Engincers .z{Z <br />� Water—� ,' /�!(S^'._'•' <br />$Ireet <br />� Communications "r-�, /� �':,...., _ ,— �. �..--1,..... <br />Tralfic <br />Planning _ <br />