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5115 <br />c'J ez ^ c' <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 improvemenl hereto applied for and <br />further agrees to remove some upon notice from the City and to replace all <br />public properly damaged thereby. <br />Inspeclar,esignalure <br />Dale <br />Variance Required <br />Yes <br />No <br />Signature of Applicant <br />Address <br />Telephone Number <br />Date <br />$ Z-//2e,2 <br />Pee <br />DEPT. APPROVALS <br />Engineers <br />Water /9/Ae•,ay. 69 / <br />Street <br />Communications r <br />Traffic <br />Planning <br />