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J i <br />Date- <br />APPLICATION FOR 3 210 <br />t,.t tt r.a c-.�.x..ct-t.0 ,`•{ .Q-L,::. iJ <br />The undersigned owner hereby agrees to hold and save harmless the City <br />of Everett from any and all claims for damapps th--t may arise because of <br />installation of the improvement hereto applied fors urTRer a"Z�— <br />remove same upon notice from the City and to replaced public property <br />damaged thereby. <br />Y- <br />Signed <br />Ld "1 /s <br />f A�- O .I.Y .A.l. )_ / RA <br />I(-- �!o " <br />Owner <br />_ 'contractor <br />