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LCisG i. <br />Lc <br />RI <br />PRGPGSEU i'1 �C--/G�/ <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 31 <� <br />public property damaged thereby. <br />Inspector's Signature <br />Date <br />S'iwsr- WE NA* A /oe'tC1e.Nr-�(,wA <br />T <br />WIU„ <br />17 C- GU fee-, raj r. -HIs EA 7Fd Y, <br />D ©wvler <br />f' •%or �tmdr Ky e-� <br />s d <br />Se�aLlc-e• <br />5"LG- <br />Engineers <br />Water <br />Street <br />Planning <br />Variance Required <br />Yes..— .................. <br />No........................... <br />t Signature of Applicant <br />Address <br />f� J�2 / / � c; <br />Telephone Number <br />/ Date <br />Fee <br />DEPT. APPROVALS <br />Mel, �7/ <br />Q�f <br />