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Permit No.-7z---..-- <br />APPLICATION FOR DRIVEWAY PERMIT <br />CITY ENGINEERS <br />EVERETT WASH <br />everett <br />�e <br />?proved By <br />�' L. Date Approved <br />The Undersigned OL, <br />Hereby applies for permission <br />At the following location 30/— 10 -5T — <br />SKETCH <br />(Work to be done) <br />Z <br />0 <br />V) <br />0 <br />Q <br />0 <br />The undersigned owner hereby agrees to hold and save harmless the City of <br />Everett from any and all claims for damages that ma'/ 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 />NoTI` <br />Insperlor's Signature <br />Dafe <br />BEVERLY <br />Variance Required <br />Yes .... <br />LANE <br />t-OL�r/� `30� <br />jot <br />•' ' 7�4 Signature of Applicant <br />[3F ro � � qo,3 <br />G Gn tj Address —� <br />Telephone Number <br />Date <br />.. K(D F F-F- <br />Fee <br />DEPT. APPROVALS <br />Engineers <br />Water <br />Street <br />Communimticns <br />