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Permit No.. Z. �5/ <br />APPLICATION FOR DRIVEWAY PERMIT <br />CITY ENGINEERS <br />EVERETT, WASH. <br />everett <br />,,e., <br />Approved By <br />r ///V.> <br />The Undersigned ��•/%i9 7�'CoN - Date Approved <br />i <br />Hereby applies for permission to r!A/ 5z*z-z- '4 di4 V �S c-. <br />Ai the following location <br />SKETCH <br />(Work to be done) <br />I' n— <br />VI <br />8 <br />z <br />N <br />�l <br />7, <br />•��.i'arAr�vrs <br />Y,,003 <br />`tlJy <br />oe <br />4lc-' !i!x LOT <br />i>.L'Q�o5FL7 LkPir�L�iOAY <br />f` ,�'?AiNgGt G9TGN �SiN <br />WETMOI?C— AVE TOl3E OAe R?/Mrz PrPOF"�k'i'y <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 all <br />public property damaged thereby. <br />pqwA <br />Inspector's Signature <br />Variance Required <br />Yes _..___...._ ..... <br />No <br />Signature of Applllicanj�r <br />Address <br />Telephone Number <br />Date <br />%off^ . 4-0 <br />Fee <br />Dale <br />Pr <br />DEPT. APPROVALS <br />