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EVrRETi, WASH. � Approved ay �— ) <br />��-�'�--�c� <br />� �� ! .% � � < Date Approved <br />The Undersigned �� �� '� / � � � � / ~ �� <br />Hereby applies {or permission to <br />! �� �-..L ? C._�= ' l� �� � .....' % f�^� ; ��%-- _ <br />At the fcllowing location `� <br />SKETCH <br />(Work to be donel <br />P,�'aF'c::7; E :-� , ": G � "�. <br />�,� �- y� ,L , <- ; , r r _:' �','("' � <br />/ ,C:' �,, <br />;�� <br />; .._- _ <br />.45� �..;�;JG. ::>��'�; � <br />� � l' ; <br />n�, i <br />l\ � �:. <br />I . <br />The undersigned owner hereby agrees to hold and save narmless Ihc City of <br />Everett from any and all claims for damages thol may arise because of the <br />inslallation and mointenance ol thc improvement hereto applicd for and <br />lurther agrees to remove same upon nolice from Ihe Ciry and lo replace oll <br />public prcperly dcmaged fhereby. <br />.li.'il' .. ., , .��� �Uiv.._ .. <br />,, .... _ . . _ __._-i <br />� �s �:� �__.�,.. <br />,.��.._. . . I ..._ . ...,� <br />.�.' _ - .-- --�{ _ `'_�;a <br />~�_ ... � <br />� <br />Inspedar's Signalure <br />SirE GyHcc�F.v '3 � / o <br />Dale <br />.. . . _.... ..�;i� <br />.. <br />,� � <br />�" i� `'� -------- t-3�'� <br />�_� <br />\ I" u� � ; <br />�--""'' �-'-'�'� _ _ ...,..�-- - ---I <br />l t�"_— ---- � — <br />✓/ .. � h,...+ e .' <br />�,�•/j j;� �fJ✓. f''�; ,'7!"ra.� <br />'%�8%7;J _ .. �,..� � � <br />Variance <br />:',: <br />��r <br />No_ . .._.._... <br />r i v-t- rc <br />SCA�E <br />;: �. . ; -_�i � •- <br />Signalure o( Applicanf <br />�� <br />�- <br />, -1, (�- ' � !�d k`v.: ��, �� ;� <br />Address <br />'� =� �) � C I ( i C:( �-- <br />ielephone Num6er <br />� � '- l � � � % �.� <br />Dafe <br />r� <br />.� .G� - % / �� -:4 _ ��:. =' ,Y r � � <br />Fee <br />DEPT. APPROVALS <br />Engineer���"'� ���� ^'��7� <br />Waler <br />Slrcet _ ' <br />Communicaliom '� ' � . ' �� ' <br />Traffic <br />Planning <br />Sr_..�C,� i2.j ��. `7`� �r�'. • ` <br />