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EVERETT, WASH. <br />The Undersigned �� %' � r' ' <br />Herebq appiies for permission to � <br />At the following bcntion `%'r <br />5KETCH <br />IWork to be donel <br />�� <br />� <br />� ' <br />� '; <br />� — — -- <br />/► <br />_ _ )`I�J�'7_" .i . <br />� ``L _. . _' _. �, � .-y. i� , <br />�; �. �i <br />i%,! ����.. <br />' �. /I�' c`- v <br />�. �. <br />r <br />Appraved By <br />Date <br />I�—/.5 �— 7� � <br />���• <br />_ . ���OR �F! ��.1� <br />The undersigned ownen c�reby ogrees to hold and save harmless the City of <br />Everell from any and all claims ior damages thot may orise because o( the <br />installation and maintenance of the impmvement hereto applied for and <br />further agrees 10 remove same upon no�ice irom the Cily and to replace all <br />public property damoged thereby. <br />M� I�RIY6���1Y 58C1'ICN <br />(7JD =C.iL�� <br />� ��a.•`'�—�,,_. •-..1:j.'�:V..__.—...._.--'�.• • j�� { <br />.�' <br />,., .._ .' .. _ _.. _.._ . . c. �. <br />�i ":`4 <br />� � �. '_ <br />� <br />.. ._ _ _..,____—._ ._._---- <br />Inspecror's Signafure <br />S/TF �i�.�-G�!.�"� �'.�1-7 ' <br />Dale � <br />Remorks <br />Cali ��, inecr;r4� �'�-�' i �'� . <br />..4 Heurs befoi� <br />;nnstruction is siarled, <br />�.�ri <br />( l;'i <br />' P!O'i � <br />C!i�C:( \':ITH 1'dF�lcn^ <br />OEPT. FUi2 �NATER LIfJE <br />LOCATIGN; RC(ORE E1cCAVATIUN <br />Variance Required <br />Yes __ .. .... . .. ._-- <br />No <br />$ignature o( <br />;'s? 2�// L <br />Telephone Number <br />Dafe <br />! �n . <br />i J L�•i <br />��.�, �a ; ; <br />� <br />Fee <br />DEPT. APPROVALS <br />Engince�(�C�L.�'„/ .O—�CU' -// <br />Wa�er . ' (, _ . �.i � � i <br />Slmef:•� - � —�-'� -- -- �_ — <br />Communications�r��.��i'ir. `-,��"��,.� <br />Tra(fic �� � � <br />�. <br />Plannin���� `-Z;`11 <br />I PP.�7dIJE f Uii — <br />PRU��ER DR��I^JAGi_ <br />. <br />