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T, WASIi. <br />The Undersigned �_�� = � ✓� ' r ' � <br />Hereby applies for perm ssion ro—" -" " <br />At fhe fol;cwing location_ - � �' % <br />SKE:CH <br />IWork to be donel <br />sp <br />I �' <br />•^- <br />J <br />TR Y� �:- �_ � r� --� , <br />- ---_- _ ---\ _�_ <br />� <br />The undersigned owner hereby agrces to hold and savc harmless ihe Gily of <br />Everett from any and all claims for damages that may arise because o( Ihe <br />installation and main�enonce of the improvement here�a applied for and <br />fur�her agrees ro remove same upor. no�ice (rom ihe Ciry and ro replace all <br />public property damaged Ihereby. <br />Ir,spector's Signalure <br />_�,rrn-�'✓�•E-s'.�-E� � -�d -7/ <br />Dore <br />CaU Cn�inr.er�nF, DepL '1.59�fiSQ3 <br />24 Hcurs �efore <br />cunsiiuetion is started. <br />� <br />io' <br />Approved By <br />� �i ,1r /� ./9��_ <br />� Dale Approved <br />� <br />Vorioncc Requiicd <br />Ycs _ _.. ____._._. <br />No_ ... . _. __ _... <br />� �f �. � ._. �� ` �� -�'G�"'2��'..- <br />'�i� � :2-i-,t-� i <br />'� / gnalure ol Applicanl <br />'� ��.� ��`"`�: /" " _ _ 'I <br />�� c <br />Address <br />_3._s :S - � G' �`f <br />ielephone Number <br />s/� �/T/ <br />Dafe � � ' <br />a ��-�U; <br />' Nt�7E <br />t�HECK �V�TH :JATER <br />DEPT. FqR V!/, i C� IJn;[ <br />I.('C�.7r_.f.< ..'��Ct;_. E�;�7,VA1�C-�N <br />Fee <br />wai�� �--.,.-:��_, ✓--.n <br />, <br />srrecr �= � T,� <br />Cammunications ��i <br />Traffic �'..,• �'�. � <br />Planning �ii % L�+ S� Z <br />� , ?�iV!DE FO-- R —� <br />; i'I;UPER DRAINAGE <br />I <br />I <br />