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EVERETT, WASH. � - -Approved By
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<br />— . . - Dole Approved�
<br />The Undersigned �--' � ' —
<br />Hereby applies for permission lo
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<br />At the following bcafion ��n � R �� L' � c r� � L�� _p� —
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<br />CiTy STo. GUR�a� SiDn�.Jn.��c <.c�„ ,= v.
<br />The undersigned owner hereby agrees to hold and save harmless the City of
<br />Everett from ony ane� all claims lor damages thal moy arise becouse ol fhe
<br />installation ond maintenance of Ihe improvement here�o opplied lor and
<br />furfher agrees to remove same upon nolice from }he Cily ond to replace o�l
<br />public property damaged thereby.
<br />DRIVEWAY SECTION
<br />NO SI:ALE
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<br />Dafe
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<br />Varionce Required
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<br />No. .. _ _ .. . . . .
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<br />Telephone Number
<br />Dale
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<br />Fee
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<br />DEPT. qPPROVALS��
<br />Erginee�._ ��Lf/`..�2�f ',�`'/ -/ ' -
<br />Water ..��I.� �i._>f:-'-7 %'
<br />Streel �' `. �� � � � �. �� � � _
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