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Permit No.,w. everett <br />ro APPLICATION FOR DRIVEWAY PERMIT <br />_u <br />C nj <br />CITY ENGINEERS ru <br />�9 <br />EVERETT, WASH. v Approved By <br />The Undersigned (�- R AT NOFr'" VF-rT- fd d1 L DF a ` J:RC. Date Approved <br />Hereby applies for permission tom A 16 ollil <br />At the following location / 6 / 4 - -71 P4I <br />SKETCH <br />(Work to be done) <br />,:-Q <br />71 sr .-'L AC E <br />i . t't' T• <br />Q <br />r <br />m <br />J <br />0 <br />U <br />The undersigned owner hereby agrees to hold and save harmless the City of Variance Required <br />Everett from any and all claims for damages that may arise because of the Yes _._.. _... <br />installation and maintenance of the improvement hereto applied for and No <br />further agrees to remove same upon notice from the City and to replace all 6 II t� <br />public properly damaged thereby. )) lV) �f <br />(ND . SCALE)- <br />Ba"..- <br />�I <br />Inspectors Signature <br />siTE G.y6C�.�) g-/6-71 <br />Dole <br />DRIVEWAY . SECTION:_:" <br />,ar <br />Signature of A2plicant <br />-G-i4VzRAf� <br />i7 i�r�l.r ,/f. ��- <br />Address <br />Telephone Number <br />p e <br />$ <br />DEPT. <br />Fee <br />Water <br />Street j <br />