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<br />Date // �� c< ;T
<br />APPLICNTIu�J Fuii �/ c�^/j� ' � % ,
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<br />,VW coK,vcR I�x�«-f' �i G�s��
<br />The undersi�ned owner hereby a�rees to hold and seve harmless {he City �-� (, y~
<br />of Everett from any and all cl�ims for demap�es th�{ may arise bacause of
<br />instellation of the Improvement hereto applted for� and further aqrees to %�;�f,�,
<br />remove same upon notice from the Cj{y �nd to replace all public property
<br />da�ged thereby, � � ,
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<br />�igned � i% �( ��� � � ,.. . _ ..
<br />� ..:�_� /s �. . —
<br />_ Uwner .
<br />``�`"� ` Contractor
<br />� `��� �/ s- i/G"ceG.-.� � � ;<.
<br />— � � �`` �.. CITY 0� �!�'_
<br />-7 ���'� ' . ,. , f APPRG' !� r/�n R[TT
<br />' �IILU !'VI1 L�I�LI-I��l.
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