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EVEREI'T, WASH. Approved By <br />The Undersigned ES %� Date Approved <br />Hereby applies for permission to ST W /G 1!-YX iE'L IJ.P: Y.°N''A ✓ <br />At the folio ving location Z4112 - 7310n 157trE77 <br />SKETCH <br />(Work to be done) <br />,GALE' 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 mointenonce of the improvement hereto .spplied for and <br />further agrees to remove same upon notice from the City and to replace all <br />public property damaged thereby. <br />Inspectors Signature <br />S TREE T <br />Variance Required <br />Yes <br />No <br />Cat <br />•1' <br />c+: <br />Signature of Applicant <br />S <br />Address <br />Telephone Number <br />Dale <br />Fee <br />DEPT. APPROVALS <br />.1 <br />V <br />Remarks <br />Engineers <br />Water <br />�— <br />Street <br />Communications <br />r. . <br />Traffic <br />Planning <br />a <br />Q <br />