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Itt%4-D' <br />E42 <br />n <br />_ _ .. <br />=r <br />a <br />c%r vfer r <br />r34 ry..... 5TP_ E T <br />The undersigned owner hereby agrees to hold and save hormless the City of <br />Everett from any and all claims for damages that may arise because of the <br />installation o.rd maintenonce of the Improvement hereto applied for and <br />further agrees to remove some upon notice from the City and to replace all <br />public propetty damaged thereby. <br />fnspector's Signaturo <br />gate ---�-- <br />Remarks—�_T_-- <br />0 <br />Vorionce Required <br />Yes .... <br />No <br />S;g6olure of Applicant <br />Address <br />c-J 1,4 C? 72 <br />Telephone Number <br />S <br />Data <br />Foe <br />DEPT. APPROVALS <br />Water�� <br />Street <br />Communications Lrr....LL.�..� <br />Traffic <br />Planning <br />