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EVERETT, WASH. Approved By <br />The Undersigned (I N A L D F� AC 11 O FAI E 2 Date Approved <br />Hereby applies for permission to Coios% 7'1'l/0 / Z' rS -ro r fU U P L'E/ _ <br />At the following location_ Z % Z 1' 66 E td Sr <br />3 T d. S T. <br />The undersigned owner hereby agrees to hold and save harmless the Ci'y of <br />Everett from any and all claims for damages that may aril • 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 />Date <br />Remarks <br />Signature <br />Cali Lu;;i.tPerin �I C'Pt <br />24 Hours before <br />construction is started. <br />i <br />r� <br />e,i'r;_ <br />31 <br />Variance Required <br />Yes_...... <br />No <br />Signature of Ap licant <br />Address <br />Telephone Number <br />7/ <br />Date <br />$ <br />Fee <br />DEPT. APPROVALS <br />/' <br />Engineers <br />Water i^ - i <br />Street <br />CommunicatJ',ons� <br />Traffic /JC <br />Planning L_u..5. //- Z2-7+ <br />