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The Undersigned.Undersigned. y`/,f• l� / ! Date Approved <br /> a ter. / <br /> Hereby applies for permission to — �=�= U, 61 <br /> At the following location Z 6 <br /> SKETCH <br /> (Work to be done) <br /> i3 <br /> 0 <br /> r <br /> O PROVIDED FOR <br /> PROPER DRAINAGE <br /> �QrvE <br /> (o / 57- ST <br /> 'tat" -�eweQ <br /> The undersigned owner hereby agrees to hJd and save harmless the City of Variance Required <br /> Everett from any and all claims for damages r'at may arise because of the Yew, <br /> installation and maintenance of the improvement hereto applied for and No <br /> further agrees to remove some upon notice from the City and to replace all <br /> public property damaged thereby. <br /> r & <br /> C Y Signature of Applicant <br /> vsl4coed � 1 .� <br /> N 0) Address <br /> 3 - 1 3 / c/ <br /> G Telephone Number q <br /> Date <br /> Inspector'f Signature <br /> C3— / 2— Fee <br /> Dale Cv <br /> DEPT. APPROVALS <br /> Remarks Engineers <br /> Water— • <br /> Street <br /> Communications r:.�k-_ ,., i' <br /> Traffic <br /> Planning <br /> APPROVED <br /> CF9:�Nr INI t s <br />