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Permit No. ........... Z�... everett <br />APPLICATION FOR DRIVEWAY PERMIT <br />r n <br />� 1 <br />CITY ENGINEERSry -.� <br />EVERETT, WASH. ntproved By <br />The Undersigned"' �3iL DAL ��/PDate Approved <br />Hereby applies for permission to C 4��5� 2 /'0�✓� �/w S <br />At the following location <br />SKETCH <br />(Work to be done) <br />%J Ty 14 VE. <br />= too <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 />Inspect gnalure <br />4/ <br />D e <br />Variance Required <br />No.. .......................... <br />�- ignalure of Applicant <br />1711 - /3rH AVE . 5.0 <br />Address <br />grTrct wASN, 934. <br />Z. oG 62- 5 3 Z_o 0 <br />Telephone Number <br />-2/ 07 <br />Date <br />$ 6-// 9 9 z 37`"` _eyIr <br />Fee <br />DEPT. APPROVALS <br />Engineer`."'^^^a^^t s. U V ' <br />We or <br />�t3 <br />Street <br />