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EVERETT, <br />The Undersigned <br />Approved By <br />A <br />l�rr, I'l �Ri-09i <br />Date Approved <br />Hereby applies for permission to ,-41 <br />At the following <br />2 -7 '- <br />SKETCH <br />(Work to be done) <br />I <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 <br />public property damaged thereby. <br />1 <br />CST <br />Inspecl5ySignature <br />Dale <br />NOTE <br />CHECK WITH WATER <br />WT. Folp WATER LINE <br />U'uDCATIONS BEFORE EXCAVA?fot4 <br />Variance Required <br />Yes__..................... <br />No_..................... <br />/ Signature of Applicant <br />,Dvv? Address <br />Telephone Number <br />Date <br />$ L-/�37tQ <br />Fee <br />DEPT. APPROVALS <br />�Engineer <br />Y <br />I' Water <br />Street <br />Traffic <br />Planning(- <br />s�f(d rUq�cr �c>✓ice// 1-NKTa/t'F' `14✓e <br />�Oe Vclocq it wtft vc y1 i <br />