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EVERETT, WASH. <br />Approved By <br />The Undersigned y —'"Hereby applies applies for permission to A q <br />At the following location—_ r ��� ZZ-Pj-/A - <br />SKETCH <br />(Work to be done) <br />7/ sr Pl-/lC,E <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 />DRIVE\SAY SLCTION <br />• <br />Inspector's Signature <br />-3/..171 <br />Date <br />Remarks <br />Call E igeeri,rr Dept. 259.8803 <br />24 Hogs before <br />constructici, is started. <br />NOTE <br />rtIECK WITH WATER <br />UEPT. FOR WATER LINE <br />LOCATIONS BEFORE EXCAVATION <br />a <br />Variance Required <br />Yes <br />No <br />Signature of Applicant 4 <br />Address e, 'S <br />Telephone Number <br />1.2 116,170 <br />Dale <br />$ S�.I <br />Fee <br />DEPT. APPROVALS <br />Engirters <br />Water 6 <br />Street — <br />Communications yg1 <br />Tro(fic �� s r.' 6K <br />Planning <br />PROVIDE FOR <br />L::Lj <br />`1. <br />