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LVEPETT, WASH. <br />Approved By <br />P� <br />�,1 h�% /9 eV7/ <br />The Undersigned t RS I NAM I I -f-o N Date Approved <br />Hereby cn?'i:-s for permission to 12' N 57 A I LI ' KWIC kE T E D/ KI <br />At the following location 1 900 — : r i `' , <br />\ SVTCH`� <br />l ork to a donel— <br />The undersigned owner hereby agrees to hold and save harmless the City of <br />Everett 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 />further agrees to remove same upon notice from the City and to replace all j <br />public property damaged thereby. <br />C5'rtA.Y. _-SICYIOH <br />(N-0 -SCALE <br />�f-YbI-'1 <br />Inspector's Signature <br />Dole <br />Call Engineering Dept. 259-8803 <br />24 Hours before <br />Construction is started. <br />l r <br />J <br />.365,:j <br />' NOTE <br />CHECK WITH WATER <br />DEPT. FOR WATER LINE <br />LOCATIONS BEFORE EXCAVATION <br />DUST-11V <br />.D-PAiA/ <br />Variance Required <br />Yes........................... <br />Water _A I" <br />Street <br />Communications <br />Traffic.—,(�,� <br />PROVIDE FOR <br />PROPER DRAINAGE <br />Signature of Applicant <br />Address <br />Telephone Number <br />Date <br />Fee <br />DEPT. APPROVALS <br />y,. <br />STor?,y <br />