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EVERETT, WASH. /- Approved By <br />�•' S11�'L..�1 ��y-� <br />The Undersigned ,f__ Date Approved <br />t � - �'- <br />Hereby applies for permission to <br />At the following location /1 - <br />SKETCH ^ — <br />(Work to be done) <br />SCALE /" • 4G <br />5ne unaersignaa owner vereuy „yloc. 1v -- •w•_ •••••••^-•• •••_ _.., -- <br />Everett from any and all claims for damages 'hat may arise because of the Yes _ ._.. <br />installation and maintenance of the improvement hereto applied for and No <br />further agrees to remove some upon notice from the Ciry and to replace oil <br />public property damaged thereby. <br />Inspector's Signature <br />1. sy X �70 <br />Date <br />./ /, .... <br />Signoure of Applicant <br />� <br />Address <br />Telephone Num or <br />Date <br />$ /Ai �• ll�� <br />Fee /7 — ZQ 8 <br />DEPT. APPROVALS <br />Engineers <br />Water Street <br />Communications <br />Communications Traffic — <br />Planning <br />r <br />