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EVFRETT, WASH. <br />By <br />�UNE . � /� �� % / <br />i %>c: / � �:! � : ,/ T 5 — �oi� n P�o��d <br />Tne Undersigned l � �_� � �—' ' <br />Hereby applies for permission fo �.��5 T G�,z/'' V� L %' �% J�=' r�i'!`O(.��1 � f�=1��]L,.G�G� <br />..: �hJc.� , G C!c.''_ ' <br />rf <br />At the following locnticn �� �% — L� ��j 7� r� _.�-� <br />SKETCH <br />(Work to be <br />� <br />C <br />� <br />U <br />rn <br />y <br />� <br />� <br />� <br />SCq L�- /'"= SO " <br />1T. <br />� <br />Cr'1U.�G /� aF J�=S �/S �.= N, C'iST <br />� . .� S . <br />c:�,2,q VEL ���%VE <br />�EMaIiE F" ��'c/'L. CL�`!'G. G✓,t-�G=• <br />The undersigned owner hereby agrees to hold and save harmless the City o( <br />Evereff irom any ond all claims for damages fhat may arise because of ihe <br />installalion nnd mainfenance of Ihe improvement hereto applied for and <br />further agrees lo remove same upon nclice from Ihe i:ity and to replace all <br />public properly damaged thereby. <br />Inspedor's $ignafure <br />�LLrh �i� t':CE � E'�3 �7`-, <br />Dafe <br />eo' <br />=�N <br />t3 - <br />Variance Required <br />Yes....... <br />No...._.. <br />�W , � <br />Signafure ol Appli nt <br />//O �d s✓'-{�t <br />Address <br />� S'3 ^ 1 `E `J 2._ <br />Teleplwne Number <br />�' �� 7�l <br />Da e <br />Fee <br />DEPT. APPROVALS <br />� G <br />Engineer :- � ��'� — <br />Waler �_-- <br />Street <br />Communimtions �� 2:: /,�.r-� �-,. _ �,.. �- i . _ _ <br />Trnfi ic — � <br />Planning — <br />�i. � <br />/ �1 <br />1 : `A � <br />