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J t�Y�e \fz `9,10`� <br />The Undersigned_ /� ��.= U�i' L 7 Dare Approved <br />Hereby applies for permission fo / ;l °i 7.�'l.=- L- C�1 ?_r' -�' ,:=�' `; - _ " / . ,r' f•r'' ,?•'. �'�:': ; <br />�%. c %J•.�7` , v� i i�L � �ilr /�%� �l/.r-r= � <br />;.r �� � <br />i,t the following location � � � � r% �' � - <br />SKETCH <br />IWork to be done) <br />____--_---- - ..._, <br />�qov!n� ; L'R <br />� PRO'�'�R DFAif�l�°,GE I <br />_ _ _._-�� <br />..,.- __ — __- <br />` �'J4�Ti'� <br />CiNECY. Vi1T�, '�1p.-rf2 <br />,_� <br />��`:?f . � � ' � �r: <br />�.n�.i�h i �... . _ .. .. _ . . . <br />_, <br />5 �C:i,VC'. :_;�(:"✓.' <br />37 <br />The undersigned owncr hereby agrces to hold and savc hormless �he C�ty o( <br />Everett from any and all daim� (or damages that may arisz hecause ol the <br />installation and maintenance of the improvement hereto applicd for and <br />fur:her agrees to remove same upon nolice from the Gly and to replace all <br />public properly damoged Ihereby. <br />y2�'° Sf. <br />�2' ,4,;r? lal�; V� <br />;-C�� � .3� <br />�� <br />Variance Required <br />Yez._. ........ __._.. <br />No. . .... ._ _ __.__. <br />� -�� i:�.�� � s, <br />`��,/'Signafure o �Applimnf <br />• <br />� <br />� �_ j <br />, <br />-.. f � i � _. �; :_ <br />^.� Address <br />�� <br />i <br />(�-/'�� ''' ,��' -3�- <br />Telephone Number <br />/ % , �'i' <br />Dale <br />` �� / > �. <br />$ �. � .�—' V <br />Fee � - � � � �i� � <br />DEPT. APPROVALS <br />Enginee�s 'v ` t . �--ti' `-v' , <br />Waler i� <br />% / uL .✓� 11 � . <br />�ji $�1C21 , ' � <br />Communications�t_...-"`' - - �„ �, +". <br />Traffic—,�f�� �� <br />Planning — <br />% (�lii>�... 7:>t'-{�:.r:;,,�.,- <br />