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EVERETT, WASH. <br />By <br />qL51-,054 IB.kgloq <br />The Undersigned "'����� ��G �( L ��JV' L Date Approved <br />Hereby applies for permission <br />At the following <br />SKETCH <br />(Work to be done) <br />1, <br />2c ' <br />7¢ rN STREET GRAYEL OR/V�, <br />.0 <br />67 <br />•, <br />/ <br />�> <br />• NOTE <br />rirm( WIT <br />n :1Z <br />WATE" <br />LATER LINE <br />r'S <br />BEFORE EXCAVATION <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 />Inspector s Signature <br />Date <br />ell <br />Remarks <br />Sc 7 %c C•iz.v<� �: A U % A/a=ry �.aCN/ie4/ <br />Variance Required <br />Yes .. __.. <br />No _._.. <br />Signature of Applicant <br />Addre <br />?5Y • C' /.1 klti <br />Telephone Number <br />�9 <br />Date <br />Fee <br />DEPT. APPROVALS <br />/\2 <br />Engine '.j a. <br />Street <br />Communications - - �' ' <br />Traffic <br />Planning <br />