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Permit No...�,�491 '1 ...... <br />t'verell <br />v APPLICATION FOR DRIVEWAY PERMIT <br />.✓ c i <br />u <br />a» ru <br />CITY ENGIN':ERS <br />EVERETT, WASH. 'J Approved By <br />11iz-1y z/4 zj � <br />The Undersigned I % L d%t l Cam Date Approve_ <br />Hereby applies for permission to rcg*l5T/E UG'i A /0 DiHI <br />or <br />At the following location /�,DA — 71 <br />SKETCH <br />(Work to be done) <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 />.DRIVV',V'AY SECTION .- <br />Inspector's Signature <br />V@%VAY SLCTION <br />(Nb SCALC) <br />..r <br />ld <br />Q <br />Variance Required <br />Yes <br />No <br />Signature of Applicant <br />Address <br />1 Z — 1 7 L i <br />Telephone Number <br />70 <br />Dale <br />f -411 <br />Fee <br />Dale <br />Remarks <br />DEPT APPROVALS <br />i-� " i <br />