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The Undersigned J' W. �� L � / �� Date Approved <br />Hereby applies for permission to -A'UC%' 20 A:-% dYli1W1L7" A-;1(/A 4,-11%Y <br />At the following location <br />SKETCH(Work to be done) <br />i� <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 />Variance Required <br />Yes <br />No.... <br />a <br />DRIVEWAY SECTION �. <br />NO SCALE signature gnalure o1 Applicdnr <br />r— <br />I" LIP <br />Address <br />1�301� 30"it <br />Telephone Number <br />0 <br />Inspector's Signature $ Date /O <br />Fee <br />D . <br />Date D M <br />Call Engineering Dept. 259-8813 <br />24 Hours before <br />7constructjOrri� started. <br />'NOTE <br />CHr,CK WITH WATER <br />OZAr. FOR WATERLINE <br />L0'r'4TIONS BEFORE EXCAVRiii7Y' <br />Water <br />Street. <br />Planning , 11 -a- ' <br />F`<OVIDE FOR <br />i- kUPER DRAINAGE <br />