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i <br />t r. n <br />APPLICATION FOR DRIVEWAY PERMIT <br />CITY ENGINEERS -:&r <br />EVERETT, WASH. / Appr <br />The Undersigned 'Date . <br />Hereby applies for permission to �Cj/ 57.4 LL tom///mil t/i9 �! v `S L✓��� — At the following locoiicn v-0�!5------ <br />SKETCH <br />(Work to be done) <br />2 ,y r'�7t2 i hJ�7"S <br />GII�y � — Ph'O QSED N� <br />f�`'Jy� I J � i •: <br />- EX/ST. S/DE SEi+-•F.0 51 <br />wETtIck-l- AV/- <br />fivers sc hcsj cn3 srvc harmless thr (np ,1 <br />T "The'undersigned owner hereby 'agrees to hold and save harmless the City of <br />Everett from an'y'bnd all claims for damages that may aiise.becouse of the <br />` installation and maintenance- of the improvement hereto applied ,for and <br />further agree's to remove some upon notice from the City and to replace all <br />public properly damaged thereby. <br />Inspector's Signature <br />Dole <br />'orE; <br />7JA'A/NA.rt• tcs/ L�Si. <br />io C3e oN sue, qs PRoF <br />Vorionce-wetuired <br />1'rt <br />Yes ............ _ ....No <br />.. <br />Signature of A <br />NO <br />•--._- �_ %ice:. <br />g�" Address <br />Telephone Number <br />--- Dale <br />.$�_ <br />Fee <br />CHT <br />