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_ <br />Permit No. -r' �.:� Z--- �� <br />! �:.. 71�- ,..!.p-� <br />/-; '_ <br />APPLICATIO�1 FOR DRIVEWAY PERMIT <br />everett <br />CITY ENGINEERS � � �� � � <br />� <br />EVERETT, WASH. pproved ey <br />�� '" 10.� `��� <br />The Undersigned_ �f'�' f?=� %'✓� $�i!'f�/�✓C . ri� �� ,7!Gf��l � ;C3t� /�.-� /� ::IJ<!/2flS Date Approv� ed <br />Hereby applies for permission to �n//,C� �O�T/%i�C�S /1i(i C: /%�%�j,�r�f�Y�T � 1'0�' f? ,��/2/011 T T ,j <br />Cls.f?C ���E�,$Ei1�iil% �r /✓fL�SSA/JV) �< i! l�f7/�r�T r O;'ni..i�t/( f /�i .����.�.,s".1 _./ R"/.� i.� n,.�.� <br />At the following <br />SKETCH <br />IWork to be donel <br />SE� <br />The undersigned owner hereby agrecs to hold and save harmless the Cily of <br />EvereN from any and oll doims for damages thal may arise hecousc of the <br />installation and maintenancc of thc improvement her�to applicd (or and <br />further ogrees to remove same upon notice from the City and lo replace oll <br />public properiy damaged Ihcreby. <br />��l«.. /� �_� <br />, <br />IL' �%� ` <br />' _ , �ir; <br />�.�-� . <br />Inspecfor's-Signofure ' <br />'� !.r <br />Dafe <br />�;4'i)rJ<r �1.�•`I'/5 <br />v <br />/� �. <br />��L�� <br />..; <br />;�; <br />.._, <br />Variance Required <br />Ycs _.. _.... _. ___.... <br />No._ ... ...._.......... <br />� . <br />;� T - <br />., . � � C. �/% , _ �������<,� <br />� 1 <br />_`.i'y,_7Y'/Gil,� ��;. ..-i� 1'✓ii'.i- <br />SignaWre o/ Applimnl <br />:..,..�_' :i�.�i�.�-..�;v :S'�„- . <br />Address <br />,, , <br />Telephone Number <br />Dale <br />S <br />Fee <br />� DEPT. APPROVALS <br />