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SI�ET�H , � � I <br /> IV�or to f�e donel �� <br /> i <br /> I o' <br /> i <br /> � Y <br /> I <br /> � C <br /> J <br /> I <br /> ,) ' i <br /> I � ; :nGf�.l_� �'n i�� <br /> 2S� ' (� <br /> !� ' � -� ------ i <br /> , I a ..� <br /> � � .�.. <br /> ,. ���° i�i i � <br /> I � � d �Q+j <br /> � I — <br /> i <br /> � ' '• <br /> � � �; 8 <br /> � , I ; ��., <br /> � � � � � ���� REMO VE r K�EPLACc 2 sT�/�' l>F �", <br /> � i � �f?G'�'. VY/TN Gr��Y��"F�_ �F <br /> ; I � <br /> Iis b u' ac• 2a' <br /> I II <br /> / <br /> The undcrsigned owner hereby agrees to hold ond save hormless the Ci�y of J(� Variancc Required <br /> Everett from any and a�l claims for damages that may arise because of �he �� � Yes. .. ._ ._._..._.._... <br /> inslallalion and mainlenance of the improvemenl hereto applied for and � <br /> � v No _. __...__..__.... <br /> further agrees to remove same upon notice (rom �he Ci�y and tn replace all II�� � <br /> public propc'ty damaged Ihereby. 1A� <br /> j n I .,.(�' -� 1 -4� � r � �/ / . <br /> � �' aCec �r✓rce �Sox � pe uc e ; ��j � �� <br /> � v� °.�✓Ic lrc l¢ I' � a l� �/QiQil!/7 ��l.10� //9!J <br /> � ,1 n � Signalure ol Applicanl <br /> U �/ <br /> � �� �� ,�0 S ���i �)� .�T" �- '/sA'dd,� 9� <br /> c� �UA i � � �l.t.' sT.. ��1 - <br /> �9� G�� v � 3 .35�- a �.� o <br /> n ielephone Number <br /> 4�� <br /> � �s� .��,� - a.� - �o <br /> � � Dole <br /> Inspecfor's Signalure S <br /> / Fee <br /> , S�i�i�. �%l�C.r�O "�3/TC' <br /> Da�c <br /> DEPT. APPROVALS <br /> Remarks Engineers <br /> �E-Waler � <br /> Stree! <br /> Communimtions� ` . , -r <br /> Tmffic <br /> Planning <br /> � ` <br />