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<br /> P��m�� Na. ��: �_�:'_: � ... everett
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<br /> APPLICATlON FOR DRIVEWAY PERMIT
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<br /> QTY ENGINEERS �'f'./ �/--"-
<br /> EVERETT, WHSH. Approved By
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<br /> u l � � I �, ' ,Q M�� Dafe Approved
<br /> The Undersigned
<br /> !t�l �TA L L �'4�v�t `= 1 2�-'� F C O N C:yt(� "i"� D ti:t i G�� �J�,Y S
<br /> Hereby applies for permission to ,
<br /> At the following location � d4' �� � �� A ��E
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<br /> IWorl: to be done)
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<br /> (N�l�.l HOUSE) �NO SC/�. LE �
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<br /> Q � �-- EX I S`t' I tdt G F'�V�t�lC1�tT
<br /> ��� �- PROVIDE 12 " CUL\/CRTS F�OtZ DRAINAG�
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<br /> The undersigned owncn c�reby agrces to hold and save harmless Ihe Cily of Variance Required
<br /> Everett irom any and all claims (or domages thal may arise because of Ine Yes __ ...... _.. _._....
<br /> installaiion and mainlenance of Ihc improvement herelo applicd for and No _.... _..... .___..
<br /> further agrees to remove samr, upon noiice from the City and to replace all
<br /> public properly damaged thcreby.
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<br /> IIn1yE��/AY _ SECYIOFJ 1 '� �
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<br /> $ignafure ol Applicant
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<br /> � � -��HO�� r�"� , � , Address �
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<br /> 23 ' Dale
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<br /> Inspeclor's Sig�olure .� �
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<br /> Dafe
<br /> DEPT.. APPROVALS
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<br /> Remarks Enginccrs �� �' � �� . .
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