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EVERE.TT, WASH. <br />Approved By <br />he Undersigned L' P • A l J L A M :3 F_ _ Dais Approved <br />r <br />Hereby applies for permission to C 61L5 r - A le <br />At the following location%/ <br />SKETCH <br />(Work to be done) <br />�11 <br />< <br />l—Y <br />I <br />I <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 mnintenance of the improvement hereto applied for and <br />further agrees to remove some upon notice from the City and to replace oil <br />public property damaged thereby. <br />V G*4144%y 5 a C Tr, ION <br />(No- SCALC) <br />Insp000rs Signature <br />Date <br />Call Engineering Dept. 259 8803 <br />24 Hours before <br />construction is started. <br />PJr`TE — ---__ ---- <br />�.r'K WITH WATER <br />,I. FOR WATER LINE <br />WINS EIEFORE EXCAVATION <br />�l)6 <br />Variance Required <br />Yes <br />No <br />Signature of Applicant <br />Address <br />%9 t i6i/l" <br />Telephone Number <br />Date �J <br />Fee <br />DE�APPR ALS <br />EngineerE ,Water .:'�•y J�:� <br />Street <br />Communicalioas 7 "'-- <br />Trani ►y� <br />Plannii <br />PROVIDE •'OR <br />PROPER DRAINAGE <br />