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Permit No..�., 7:)A _ Z <br />APPLICATION FOR DRIVEWAY PERMIT <br />CITY ENGINEERS <br />EVERETT, WASH. <br />';sett <br />Approved By <br />y— T2/,d ti�G G� Date Approved <br />The Undersigned / UzE /l1� <br />Hereby applies for permission to 0AJSZ -:5 oA-1 C <br />At the following location �— , 7 G A ✓t <br />SKETCH I�Gq.VT I PEA <br />(Work to be done) -7-- <br />I <br />ko W t� <br />t1 Q <br />QZ;�QU <br />CCun/C. DR/ 1 /E <br />/TYSrND. C0A/C, 5/w;Cf <br />Sim <br />ETAlAllkG IIA: _ <br />ARh/AG SrALL5 <br />eq9 <br />I�/�LAtiyTE,q Ak'�A <br />Ib 7 <br />432 <br />16 <br />SCALE /"-40 <br />TSB .STD. :41N/, CMG <br />ra A(/cA./CUE <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 for and <br />further agrees to remove some upon notice from the City and to replace oll <br />public property damaged thereby. <br />Inspector's Signature <br />Date <br />Variance Required <br />Yez... <br />No...... <br />n f-: <br />Signature of Applicant k'al�r .�-•�` <br />„�� jq�-7�y AddressC(,/�yy,(.�i-tr�✓ y8%2� <br />3 Sid �uu G/rr%�: ✓ <br />Telephone Number <br />Date <br />$/)J/jp <br />Fee <br />DEPT. A <br />Engineers' G'� / <br />Water. 1 r"iC. <br />Streery L z ��1cCy <br />Cemm:!cirations......� _ r ---- <br />