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Permit No.J- .1....._..... evere'rt <br />APPLICATION FOR DRIVEWAY PERMIT <br />CITY ENGINEERS <br />EVi i:ETT, WASH. A proved cy <br />The Undersigned__ r, 0 Al Al v' t 3 9�.—S !r Date Approved <br />Hereby applies for permission to :ro tT% / 6 Al 47yZS -tZA(6 b RI it r 5 / 0 Al <br />fr C' u i v U i-2 ci E <br />At the following location / o0 4 4 k 8 3 <br />Q / iol - 33 R o S7' <br />SKETCH ! 2 3 <br />(Work to be don g) 14 — <br />`V <br />k <br />k za r <br />Alev, <br />KO <br />EGl <br />Plaana-v ''� <br />4 S -7 <br />5�E ti� <br />5 I � <br />r <br />C O RS <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 properly damaged thereby. <br />n <br />Inspector's 'Signature ✓ <br />Dat <br />Variance Required <br />Yes. . .. .... <br />No... ..._ ...... . <br />Signature of Applicant <br />Address <br />C � 4 4=t4g' <br />Telephone Number <br />Date <br />$ <br />Fee Qj a J <br />i2 r <br />t <br />DEPT. APPROVALS <br />R <br />Engineer <br />Water <br />Street <br />