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� "-=4a" <br />�n <br />., <br />r <br />35 <br />ja ,BE C.-,:: � r.a = r <br />3¢ <br />� <br />„� <br />The undersigned owner hereby agrees to hold and sove harmless the Cily of <br />Everetf from any and all claims for damages that may arise because of the <br />insfallafion and maintenance of the improvemenf hereto applied ior•and <br />further agrees to remove same upon notice from ihe Cify and to replace all <br />public property damaged Ihereby. <br />� <br />� <br />M <br />� ,� � �i <br />c:'�f-i�t�i' ��, ly�.--�c<J-� `sf.. <br />Inspeclo�nafure %7 <br />S�/ 9�G `% <br />0 <br />Dofe <br />/'• /� � / . <br />.,GLi�c,�wl /J,l-tt ��:�- r7.ti-n-.-�;T /I� C'r= ;i.�-n.l-L n �� <br />Remarks % � <br />�ONSTRNfT10N <br />�c450/J : <br />�� �� -. <br />Ta C'� _ -" : <br />, '. <br />Variance Required <br />Yes. _............ _.... _ _... <br />No.. _......... _....... _.... <br />� � O I 1 I �_. <br />� � L .CL- _�,t-� <br />ignature oF Applicanf <br />� / �t <br />���'� �' ��C'L;��/r.Cc (� = � <br />Address <br />��-�� -/��.� <br />ielephone Number <br />� _ �� !1 ii `�� � i; <br />/ Dafe <br />S <br />Fee <br />DEPi. APPROVALS <br />Engineer <br />Waler 21 / LD <br />Sfreet � � <br />Communication �" • `a ""'�`r �/° <br />iraffic � <br />Planning _ %' N�? • <br />