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At the following location _ L <br />SKETCH <br />(Work to be done) <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 />ell '71-7o <br />M <br />Inspector's 5@nature r <br />_le Z�� <br />Date <br />Variance Required <br />Yes..... _. <br />No <br />Signature of Applicant <br />Telephone Number <br />Date <br />Fee <br />DEPT. APPROVALS <br />Engineers® Al <br />Water <br />IY <br />Street <br />_ rt <br />Communications <br />Planning <br />