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i, - � '; ' <br />The Undersigned i�'� ' ' " � � � f � - ' Dafc Approved <br />i ., r_... .:.r/ !.>� i <br />/ <br />Hereby applies for permission to_ �� -�- --�-"--��''' ' - <br />. ;'i' <br />At the following <br />SKEI �H <br />(Work to be donel <br />'-� . . . �� � '/"� . <br />'(he undersigned owncr hereby agrees ro hold and save harmless the City of Variance Required <br />Everett from any and all claims tor damagez that may arise because of the Yes. . .. _. <br />insfallation and maintenance of the imprnvemenl hereto applied for and No ..... ....��. <br />furiher ngrees to remove same upon nolice from the Cily and to replace all <br />public property damaged thereby. <br />y(I_�,�..,��". �L`l/J4' <br />` t`�(7T� , �'`��f' <br />CHECK 1}JITH W.47ER <br />�==f=�. ��R \'/ATGR LINE <br />L(iCA'fl0i^.S �E;=U ie. EkCAVATI(7f1 � Pqd//!� <br />;I .-�c _ ' ... <br />Inspeclods Signafwe <br />/ <br />--i <br />'j ' % <br />Do% <br />, <br />r <br />� <br />`/ / �/i �L� <'../.i 1 , �� � i � :s � r . :i <br />Signafure of Applicanf <br />� ii -% - � `7 ,�- <:�: �, -/_ <br />/ Address <br />3�� - 9/a�i <br />Telephone Number <br />� - � �—G> <br />Dale <br />s Nn T�'� <br />Fce <br />DEP'. APPROVALS <br />/ <br />Enginee�� .�_ . � �_ , �_ : =- . <br />Walcc� , �� <br />Strcel-7`J'c,''-'^. "Li bM-i nd./ ,7L'... , . <br />Communiwtior� � ' ��� ��� <br />Traffic � _ <br />Planning � �� �� <br />t'. <br />