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APPLICATIC&,! FOR DRIVEWAY PERMIT <br />2 <br />EG/ o/G C D <br />everett <br />0 <br />�._ ��. <br />roved fly <br />`Iee(ylbw 1l, IIZ4zq-- <br />Date Approved <br />2-ASP, Con/G. Oz VES, Q <br />9� rN PL; <br />[19 <br />rees to hold and save harmless the City of <br />for'I,moges that may arise because of the <br />fneimprovement hereto applied for and <br />p"n nonce !rom the City and to replace all <br />Variance Required <br />Yes........ _.................. <br />No. ....... ........ .. . <br />I <br />�j M <br />?G° G��1r /. ���!-� i..i-;l �•- `=�`•`-'" Signature of Aptalfcant <br />.{4,t' �b i�� N-i�% r G'ELLF✓iv� <br />Address <br />455 SSs,r <br />Telephone Number <br />Date <br />r. . <br />Fee <br />