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At the following location ,-- '� r ' "' <br />. i r <br />SKETCH <br />(Work to be done) 1e <br />PEX 7ER <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 />liped Signofure <br />Fate <br />Remarks <br />Variance Requ; ed <br />Yes <br />No <br />EngineeWater <br />Street <br />Communications <br />Traffic <br />Planning <br />3 - -7 -1 u S <br />Telephone Number <br />I \ . \Cl hr� <br />Fee rJ <br />DEPT. APPROVALS Pb j'J1 ( Di 4 <br />