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EVERETT, WASH, proved By <br /> / or-4p 1. 1�'ijcQ _ <br /> The UndersignedS;'' —� "t r- (�� — �'- '�'? � ' _ __ Date Approved _ <br /> Hereby applies for permission to—iLoE' - <br /> en <br /> At the following location . gam' — <br /> SKETCH J <br /> (Work to be done) <br /> CHI /r) <br /> DEPT „ , ;E I ii <br /> 1.0CMTIONS BEFORE EXCAVATION <br /> h <br /> 3. 0 <br /> ' NOTE <br /> CHECK WITH W iER <br /> DEPT. FOR WA- .R LIN�—; <br /> LOCR!IONS 6EF RE EX07�VATION \ <br /> The undersigned owner hereby agrees to hold and save hnrmless the City of Variance Required <br /> Everett from any and all claims for damages that may arise because of the Yes_._ <br /> installation and maintenance of the improvement hereto applied for end No.. .. <br /> further agrees to remove some upon notice from the City and to replace all <br /> public property damaged thereby. ""D <br /> Z> <br /> '"• r3/V Signature of Appticant <br /> K) <br /> Address <br /> Telephone N,rmber <br /> Bate <br /> Insffecfor s Sirl"1ro $ <br /> Fee <br /> Date' <br /> DEPT. APPROLS <br /> Remarks Engineers VV` <br /> Water <br /> Street <br /> Communications ' <br /> Traffic <br /> — ---_-- _ - _ -_ Planning <br /> t': <br />