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/t'/�ARr✓N _�ti <br />The Undersigned AR 2 Y M C O Y Date Approvers _ <br />Hereby applies for permission to tE/eF C T <br />- Tf�� 4' cI l�✓A� <br />At the following location /59 S 7 `s" yd- � 7' <br />SKETCH (I <br />(Work to be done) <br />i <br />A.LLte y <br />J <br />The undersigned owner hereby cgrees 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. —WO <br />DRIVEWAY SECTION <br />- NO SCALE ..r <br />r �-7- 7} <br />Inspectors Signature <br />517A: <br />Date <br />Remarks <br />Variance Required <br />Yes <br />No <br />X� 4W. -}l2 �a <br />'SVnature of Applicant <br />Address <br />3S3" Jb4o <br />Telephone Number <br />Date <br />_ $ No FE E. <br />1 Fee <br />iL1�_ C <br />73 <br />El PP�JtlS <br />Engineer J J'��^J '73 <br />Water <br />Street - <br />Communication I - <br />Traffic <br />Planning /L•'ETl '�— <br />