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7/cS <br />Date 12— /5 — 65 <br />Pq <br />APPLICATION for G V L UC K'E R /9 ✓E <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 installation <br />of the improvement hereto applied for, and further agrees to remove same upon <br />notice from the City and to replace all public property damaged thereby. <br />U6e7 i- L mac! . <br />/(1po <br />Signed <br />1— —15 /� <br />Lr <br />T <br />5' <br />1 <br />T <br />5 <br />1 <br />Location Approve �' _ � <br />LEVEL <br />Owner <br />Contractor <br />T <br />5' <br />1 <br />T <br />5 <br />1 <br />Location Approve �' _ � <br />LEVEL <br />Owner <br />Contractor <br />