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EVERETT, WASH. <br />1 <br />By <br />The Undersigned j% /Z <br />Hereby applies for permission to C�� �/ <br />At the following <br />SKETCH <br />(Work to be done) <br />A SA=f/AL T- ., o,. /� i, i.. 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 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 />Inspectors Signature <br />S�; /• /j 8�670 <br />Date <br />C`7t <br />Or 1 C ✓, <br />4M45;a s.—" % /i%D- Date Approved <br />Variance Required <br />Yes ..... <br />No <br />.DI t1 c-N <br />2tlzwA2/nD �rnwooK <br />Signature of Applicant <br />RDO.� ���1"sT• <br />c �nsON U S <br />Address <br />}�dL 85S86W _ <br />Telephone Number <br />v <br />Date <br />s p o <br />Fee <br />DEPT. APPROVAL <br />Engineers-- <br />Street <br />Communications <br />Traffic <br />Planning Fyf� <br />