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EVERETT. WASH. <br />The Undersigned 17 G' 46' /7 1 96< t t7 <br />fly <br />Date Approved <br />i <br />Hereby applies for permission to—l'o--v s � A /D D.�.a7 • Y; rt <br />At the following <br />SKETCH <br />(Work to be <br />/' �,, ,.. <br />(� nTE <br />.Ir <br />LXCO <br />O <br />s` 4 <br />96 \VI <br />�I <br />vl \� <br />101 <br />ASP. CONC. <br />E3 S t SEE 7- <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 ,f 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 />Inspector's rsignoture <br />2 7 rF <br />Date <br />Remarks <br />V•srionce Required <br />Yes <br />No <br />N <br />M <br />�Gal_f <br />4 <br />M' signature of Applicant <br />S <br />Address <br />38� - 7977 <br />Telephone Number <br />Date <br />Fee <br />DEPT. APPROVALS <br />tt�� <br />� <br />Engineer ti—A. 1\/ � '• <br />aler <br />Street — <br />Communications 7,` <br />Planning <br />. <br />c: nAaNS G r <br />f <br />