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EVERETT, WASH. <br />Approvcd By <br />The Undersigned 2 t i S S 1, L L A C LA R V Date Approved <br />Hereby applies for permission to FILL L CI2011 F DGE OF <br />)FjF_P.s0 Al ,Go fL Tf/i s 15 To PAR k Ni a ci9 R f3 CCA US E of 7 E s7w'&�P III «. <br />At the following location Z S��y Z 4L-01 :5 , <br />SKETCH <br />(Work to be done) <br />6 nd <br />TF-HVdtl,A2r <br />UNTIL sTRcfT'ys <br />.ZH,p20 UC G: r <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 />h/07E ; TjlE O tiny a 2 [Ue uL O L ACE <br />%IV/s FIILr•.v IN 7'D pf}RlL-1 <br />1415 CAR. kV �\ /V/ <br />\k' J <br />All <br />N <br />0 <br />Inspector's Signature <br />Date <br />,�82,� <br />5 <br />R� �Extsr <br />aM/ ulm/. OC OLOCKED <br />ST. <br />Variance Required <br />Yes ...... <br />No__.. .__.. <br />Signature of Applicant <br />74/I ll2.i1d f <br />Address <br />Telephone Number <br />k. /9y2 <br />Dale <br />$ iU O <br />Fee <br />EPT. APPROVALS <br />Engineel 1 Z <br />Water - <br />Street <br />Commun'callo <br />Traffic B A• �✓ 2 <br />Planning 1+ 5 1 - 2 <br />�sw <br />