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ryFl.cTT WASH. tproved BY <br /> ve <br /> r ( Dote Approved <br /> Tho L1nJersigned-),—,_', r.� <br /> 00 <br /> Hereby applies for permiuion <br /> At the following location._ �.. �,;a <br /> SKETCH ----- — - - ---- I -----------� -.—. <br /> (Work to be done) <br /> DEPT. NE <br /> .�40CA1 IONS 13tiFCRE EXCAVATION <br /> o 6.' '1/C;` f , {.•rte <br /> . NOTE <br /> CHECK WITH W n'R <br /> I DEPT. FCR V,'A1 .R LINgj <br /> WCA%NS fill' RE EXQAV.A71ON <br /> I <br /> The undersigned owner hereby agrees to hold and save harmless 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 and No <br /> further agrees to remove some upon notice from the City and to replace oil <br /> public property damaged tliereby. <br /> Signaluro of Applicant <br /> ,M <br /> Address <br /> Telephone Number <br /> Data <br /> Inspeclo;s siggofwa %— $ <br /> Fee <br /> Dole <br /> DEPT. APPROVALS <br /> A 1 1 <br /> � C C <br /> Reaerks Engineers tt- f` "•vim. <br /> Water— 'ti �� <br /> Traffic <br /> —_ _-- _•—_ Planning <br /> s, <br />