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Permit No.33.53.._;_ everett <br />APPLICATION FOR DRIVEWAY PERMIT �e <br />CITY ENGINEERS <br />EVERETT, WASH. Approved By � <br />✓��('E'S/,�' [ <br />The Undersigned Dale Approved <br />Hereby applies for permission to /rDNST. W A; r /?4liEL 1-;e—zY<N'A !/ <br />At the following location 24112 - 73Tp 5/:?r T <br />SKETCH <br />(Work to be done) <br />5cA LE : I" <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 />Inspector's Signature <br />Variance Required <br />Yes <br />No <br />C` I <br />�r <br />Signature of Applicant <br />Address <br />Telephone Number <br />Date <br />Fee <br />DEPT. APPROVALS <br />cr <br />Engineers ,.d�►-Q <br />Water <br />Street--�-- <br />