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EVERETT, WASH. Approved By <br /> Date Approved <br /> The Undersigned <br /> Hereby applies for permission to <br /> At the following location <br /> SKETCH <br /> I(Work to be done) <br /> ►l' --- - - <br /> o.o " <br /> r� <br /> i ato <br /> I'M <br /> i <br /> !� 5 4 <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 all <br /> public proper't damaged thereby. <br /> Okws: :oY 5[CTIoN <br /> (Nv S:ntS) FIVT AY SECTION <br /> Signature of A icanl <br /> f6 is^,,i . .... . _- �O rte. I• »_� W I Address <br /> f' (s 1 n S e s I e Telephone Number <br /> Op Date -� I <br /> Inspector's Signature $ O Jaw 4a <br /> Fee <br /> sn3- Ci��GKED 3�2��i/ <br /> Date <br /> DEPT. APPROVALS <br /> Remarks Engineer _ 3�'f/7/ <br /> Woter <br /> Street <br /> Communcali <br /> Traffic <br /> Planning rwr l-' <br /> 4� Y� <br /> NOTE I f�ROVIDE FOR <br /> Q/II Eng;,leering DePt. CHECK WITH WATER VROPER DRAINAGE <br /> 2598803 DEPT. FOR WATER LINE <br /> 24 Hours before LOCATIONS BEFORE EXCAVATION <br /> Construction Is startod. � <br />