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EVERETT, WASH. <br />By <br />The Undersigned " O I3 /[ 6 lr-- <br />Hereby applies fer permission to. <br />At the following location <br />SKETCH <br />(Work to be done) <br />13 r1lX V 5 <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 some upon notice from the City and to replace all <br />public property damaged thereby. <br />In�s-pedo tgnalure <br />l.9 <br />Dafe / <br />Remarks <br />�1u1 4 17a \ 4ta4 <br />s Date Approved <br />Variance Required <br />Yes.. _... _. _..... __...... <br />No. <br />tJ) <br />rgnature of Applicant <br />1-7/1 - 13rN AVE S.(A/ <br />Address <br />5e47ret w,4sN. 9 /34. <br />_ ZOG 6Z5 3Z00 <br />Telephone Number <br />7-2/ - e'? <br />Date <br />Fee <br />DEPT. APPROVALS <br />Enginee f'�-- <br />W1 4z O�4t3 <br />Street <br />Communications <br />Traffic <br />Planning <br />