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At the following <br />SKETCH <br />IWork to be donel <br />� <br />��-/L r' <br />/ '� L <br />� � r. <br />,.- <br />The undersigned ownen c�reby agrces to hold and save harmless Ihe City of <br />Everett from any and all cloims for damages thal may arise because of Ihe <br />installation and maintenance of the improvement hereio applicd for and <br />further agrees to remove same upo� nolice from Ihe Cily and to replace all <br />public properly damaged thereby. <br />i ry �- , <br />-�����.. ' :)i• <br />Inspedor's; Signalure ' <br />J. �= ' ����' � <br />Dale <br />��L%���, <br />�� � <br />Variance Required <br />Ycs _..__. __... _.... <br />No..._ _.. _.._...... <br />` % .G ��i i , � '�c 7.�`'r` j <br />,'.?��,_/�'/GiLN ��0�� G'7d Wr�� <br />Signafure ol Applicanf <br />�'..5':�,� /Il�i/}'i-OiV /�v!-- <br />Address <br />v <br />;'t i, ?/�� l <br />Telephone Number <br />, Dafe <br />� <br />Fee <br />DEPT. APPROVALS <br />/� � . i � /�i <br />Enginecrs <br />Watcr_ <br />Streel `_:; <br />/ <br />Communi <br />Traffic— <br />Planning , <br />