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Permit No...r.G� — 5 <br />................ everett <br />APPLICATION FOR DRIVEWAY PERMIT �e <br />CITY ENGINEERS i / . Ct. <br />EVERETT, WASH. Apprmed By <br />The Undersigned r o N r: t' L f U I tJ Date Apprcved <br />Hereby applies for permission to C o N S 7' /4 / D DlL!/ <br />At the following location <br />SKETCH <br />(Work to be done) <br />QKLA 1.10M/-\ AVE, <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 fnr and <br />further agrees to remove some upon notice from the City and :o repla.:e all <br />public property damaged thereby. <br />Inspector's Signature <br />/ / AL_ <br />Date — — <br />8 <br />—I <br />J <br />_._ ice <br />NC-vJ Slit) Is To g6 <br />J1J Z;-71i L t. C D ,7b MIMI <br />F�l�%v✓G I <br />Variance Required <br />Yes _ <br />No _... <br />Signature of Applicant <br />3, iyIl r- <br />Address <br />Telephone Number <br />.7 _ - -7 L <br />Date <br />Fee <br />r <br />DEPT. APPROVLS <br />Engineers,--�—•� %�. <br />Water ' — T Z /O - 7 �-- <br />Street <br />