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E v�,� E rr A v� . <br />Thc undersigned nwner hereby agrees to hold and save harmles� fhe Cily of <br />Everett Pom any and all cloims ior damages thnt moy arise becaise of the <br />intlallali�m and mointenoncc of thc improvement herefo applied for and <br />furthcr ogrees to remave some upon nolice from �he Ciry and lo replc•e ali <br />public p�operly domaged ihcreby. <br />'"Af` <br />Insprdor's 9iynalure <br />� �K��Iit�� b �L-� /`%i <br />Dare <br />��v �✓ifJ�,i% �//�.t�la�i%/�K <br />� <br />�IJ <br />`J <br />'J <br />� <br />�_ _4 ,-�� <br />Variance Required <br />Ycs <br />IV o <br />Signafwe a6�APplicanl �. <br />� � A�dress �` <br />_ , �,��, _ <br />Telephone N�mber <br />Dafc ^ <br />$ / V� <br />Fee <br />DEPT. APPROVALS <br />c• � ' <br />Fngincer � / <br />Walcr � � <br />J <br />S�fCC1 _ _ <br />Communicalio �� " � <br />Twffic 1 � — � � '� � <br />Planninp f y- � �' <br />.� d.+rh Caf .f.r !�r�.-�...�, r�..,.�:1 <br />/. ... r �,.:�.-. � /u, %li f .. /l �! r,p /t7�' C.rr�G. <br />m <br />