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EVERETT, WASH. <br />The Undersigned ` U1 04Z `� C Off/ <br />C QE1VZ WAy ©tip 5� �_ /U r� ✓ G .vn/o <br />Hereby applies for permission to R�,c�ACE <br />On�G . L^U�2 • <br />At the following location <br />SKETCH <br />(Work to be done) <br />Approved By <br />MW y zz , i9r'o <br />Date Approved <br />W <br />7 � <br />N <br />r <br />i <br />2f t` G�Ra O <br />a. <br />G'� /VE 'A <br />72"° CO <br />The undersigned owner hereby agrees to hold and sore 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 (hereby. <br />✓.a.ie.,•... � ccr�oN <br />(No SCAT.t') <br />Inspecfors Sipnafure <br />Date <br />+DRIVE\JAY SECTION__' <br />..A <br />dc-(/'4 [ <br />T/70 <br />CfWid A ` �� Lr�i. <br />Variance Required <br />Yes <br />No <br />Sionalure of Aonli ant <br />gaalel <br />Telephone Number <br />Date <br />$ .r <br />Fee <br />DEPT. APPROVALS <br />Engineer( ` n��e /Z M <br />Water I <br />Street . <br />Communications <br />Traffic <br />Planning / — <br />