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EVERETT, WASH. <br />By <br />`��-� . ^ Oc�o�er 23,Iq1o9 <br />The Undersigned �'O ='� � '' � ` -� Date Approved <br />Hereby applie: for permission to �� j%>� �� r�—•� 'J� �'�� _ <br />At the following <br />SKETCH <br />IWork to be donel <br />J `/ `.:;:</ , . ,,� . ! <br />The undersigned owner hereby agrees to hold ond save harmless thc City o( <br />Everetf from any and all claims for damages that may arise because of the <br />installation and maintenance of the improvement hereto applied for and <br />forther agrees to remove same upon notice irom Ihe Ciiy and to replace all <br />public propedy damaged Ihereby. <br />� // <br />uv'�� .s �i+-..�M.y <br />Inspecfoiy oignolure ,f � <br />lo/ �/69 <br />Dofe <br />Remarks <br />,� <br />G:; <br />..� <br />Variancc Required <br />Yes. _ _.._._.. _._._. <br />Na. _._.._._... <br />Signafure of Applicanl <br />Address <br />ielephone Number <br />Dale <br />S <br />r�� <br />DEPT. APPRGVALS <br />Engincer� j �/ � � <br />Walcr� <br />$I, ect � <br />Communicafions ��' � «� � <br />Tralfic <br />Planning <br />