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At the following location_ % D _—=— ,>� , �e . c <br />SKf:TCH <br />(Work to be done) <br />a2 ST• <br />The undersigned owner h by agrees to hold and save harmless the City of <br />Everett from any and c aims for damages that may arise because of the <br />installation and muinte. nice of the improveme-I hereto applied for and <br />further agrees to remov- some upon notice from the City and to replace all <br />publir property damaged thereby. <br />DRIVEWAY SECTION <br />NO SCALE <br />� 2 55t - - --� <br />LIP -- <br />f0 30'.1� <br />Inspectors Signatule <br />Dote <br />11' <br />ys..l•," �- <br />Variance Required <br />Yes <br />No <br />r <br />a. z <br />Signature of ApAtkont <br />—Address <br />i <br />Telephone Number <br />Date , k'o /.y_ <br />Fes <br />�••,. far; <br />DEPT. APPROVALS <br />Engineers �, <br />Water <br />Street_; ? � <br />Communicalions !-y—�er�-'-•"e wv ''�•"�•e <br />Traffic <br />Planning _— <br />