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Permit No. _ ./.....'_....', Y <br />APPLICATION FOR DRIVEWAY PERMIT <br />CITY ENGINEERS <br />EVERETT. WASH. <br />The Undersigned <br />Hereby applies for permission <br />At the following location <br />SKETCH <br />(Work to <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 same upon notice from the City and to replace all <br />public property damaged thereby. <br />' NOTE <br />CHECK WITH WATER <br />DEPT. FOR V.AlIf; LINE <br />LOCATIONS l3EFURE EX.:4A1ICA <br />lnsped s Signature <br />6everett <br />Pd By <br />Prove <br />14 Flnq pro <br />D Approved <br />Variance Required <br />Yes <br />No <br />Signature of Applicant <br />Ado. ess <br />Telephone Number <br />r� <br />Date <br />$ -!E 0 /-lfl89 <br />Fee /e/// <br />o r )hL/ <br />USPy <br />DEPT. APPROVALS <br />Remarks Engineer <br />Water. " <br />Street - -- <br />