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EVERETT. WASH. <br />Approved By <br />�Ji= pTi'ti�t3.�=� 0 % �fi <br />The Undersigned i�—� —� �'� %� T� J� ' j�� Dale Approved <br />i <br />� f __ .- - , i,� -. . <br />Hereby applies for permission to 1����T�L��.�� �-'�' �" " <br />At the following location % � '� i7 " -`> ���D�!�n' ;h" - • <br />SY.ETCH <br />IWork to be donel <br />The undersioned owner hereby agrecs lo hold and save harmless Ihe Ciry a <br />Everell from any and all claimz for damages that may arise becouse of Ihe <br />inztallalion and mainlenance o! the improvement hereto applied for and <br />(urther agrees to remove same upon notice Irom the City and to replace all <br />public property damaged thereby. <br />:'•; <br />`_i.. <br />Inspecror's Signalure <br />�Y % <br />j�.= c��'«r� /9�70 <br />Dalc <br />I� u� � <br />c, <br />'� <br />` <br />� <br />�V <br />\ � <br />L Y/SY• <br />�; u�eG <br />PRCf'05�D <br />CoNG, ,DRI <br />; � f1/.f�i%/�!/ �ti� <br />y Gurr� <br />P. C, <br />Variancc Required <br />Yes.__.__.___._. _... <br />No._....._ ....__... <br />'� � � . <br />$ignalure al ApplimN <br />Address <br />iv ( � S SYGAMORE <br />'lelephone Number <br />259—�0�4 <br />� <br />.�., �_. _ ' `i`9 <br />Dafe <br />� <br />S 5, ° — i'D <br />Fee '� — � O� ( � <br />DEPT. APPROVALS <br />Fngincers:.� �c�r/ q/w Tn <br />wa���� � F`-�-=— <br />s�«�� -T �— <br />Communicalions -��`'`��� <br />Traff ic _ <br />Plannin� "� tR'� i� y� 7Q <br />