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I11=401 <br />E -)c, <br />LL-5] <br />0 <br />et�3 4 TA/ <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 ariso because of the <br />installation and maintenance of the improvement hereto applicd for and <br />further agrees to remove some upon notice from the City and to rcploce all <br />public property damaged (hereby. <br />i i rt W. •t , .. r :-�l <br />l i / r..1'„' r . <br />f'/'fi / C� <br />•�irtl „�•f. f._::J ti.: <br />r <br />: \}i. (�.uci � r <br />/ <br />l tnector's Signolure <br />Doh <br />Remarks <br />Variance Required <br />Yes .._.. <br />No <br />Sig6aturre of Applicant <br />�t <br />Addrre1rss <br />Telephone NumbA{ <br />er <br />cafe <br />S <br />Fee <br />DEPT. APPROVALS <br />/�J <br />'41I ry_I p` Fnygineer sJ., --- <br />Water <br />'r <br />Communiralions <br />Traffic_ <br />Planning _. <br />