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EVERETT, WASH. Approved By <br /> f� Date Approved/��y / S � ) <br /> The Undersigned s� , <br /> Hereby applies for permission to ��� Q 9/ �� 'Q e ig' f i7 G <br /> At the following location <br /> SKETCH <br /> (Work to be done) ` <br /> 70 <br /> J15' ?G rAy PLACE <br /> cA/C, 011. oeeMOVe � ZEP, Ce,vL GvAeP <br /> N --- <br /> N <br /> Csl kV iWtK. -...5 .fOH <br /> (qII-`SC1t1 ) <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 impuvement hereto appried for and No <br /> further agrees to remove same upon notice !,am the City and to replace all <br /> public property damaged thereby. <br /> ,QRWf"sWAY._&iCT10N_•.:' <br /> �...��� Signature o1 Applicant <br /> 1 �/r_-°� Address 9B27A <br /> t0 #MR"-V, RWn9S#, <br /> Telephone Number <br /> Date <br /> Inspector i Signature <br /> Fee <br /> S/TE <br /> Date <br /> DEPT. APPROVALS <br /> 0 <br /> Remarks r1 r(_, c �a e. 41e, NUJ I r Engineers 4 20 <br /> 1 Water i — <br /> Ctreet <br /> -- <br /> Communicationsn 1 <br /> Traffic <br /> __ Planning <br />