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EVERETT, WASH. Approved �y <br />, � ,-y�-• <br />, - l��i�i �_ r-':.� ". _" <br />�� � �h ��, . � . - -'- Date Approved <br />The Undersigned �L`�'— -- L � '— <br />��s , :, <br />_ �', .f. �_ -- L � r � _'" ' '-- l=-' - <br />Hereby applies for permission to `�;� � ' - �' � , t-' — ' , ' _ <br />At the following bcatioc—.j �% `-� `� -�' < <" r�- '-' � <br />SKETCH --.�mn�.` � �" <br />(Work to be donel I � � i� �,GAI.0 -- ' _ — <br />'�TATE <br />�i <br />� <br />� ..� -T_. _ -_ ___. ___, <br />� <br />i <br />, <br />ALL�y <br />Thc undersigned owncn c�reby ogrecs la hold and savc harmless thc Cily of <br />Everell from ony and all cloims for damages thot may orise because af the <br />inslallolion cnd maintenanre of the improvemenl hcreto applied for ond <br />lurther agrees b remove mn¢ upon nolice from Ihe Cily cnd ro replocc oll <br />public property damaged Ihcieby. <br />�. �#,� C E(C-�/? ; - _'� <br />Inspedor's Sigr�ture � <br />J� <br />�S ir � ..v�L-.-c :,e'r/_' �{-1. , . <br />Dafe <br />Remarks <br />. �..�. .:tz�led. <br />; .� <br />. . -;,,� _ _. .. _ . _ . _ <br />i <br />;} I Fi�Of ER Di;RI��r1G. ' <br />_�. <br />, �- <br />� f� � r> -;:. r.. �' _ 3�_I-' i r:_�,-1 _.-. <br />Varioncc Rcquired <br />Yes .. . . . _ . . . ...... <br />No. .. ... _.. . <br />. . <br />;: ,�, <br />�,�L^!.• . �.F. ��r �%`r`�f.f,..:� ' � i <br />Signalure bl Applicanf <br />%!' i G ^'G.�. �ic L--' <br />Address <br />�� � Z � � � ��� <br />Telephone NumberT <br />, <br />.., � �� ' i �� !�. .7 �7 /id r'� J <br />� f�'r.,.. � �.�<a-.. ✓,. / - ! � � J / <br />Dafe <br />s �.t� �� � <br />' �,�,. Fee <br />i-� �..� 1�„tf. <br />.� `i ,� % > <br />DEPT, APPROYALS <br />.�l/' i'/ <br />Enginceri �--�`�-Cr<G• <br />Walcr �....i_ � ' �� .. <br />$freCl �` �' <br />Communiwlions�. "� <br />Traffic ��� - -� <br />Planning . � � <br />NCF' <br />CHe� <br />DEPj, �, . , , „ <br />OR WAiEIt I � <br />IOCATInp�c nrrn. <br />� <br />.n�.y�.. <br />