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� ����n� � t�(��i, <br /> �`i j.�..��_-F��' Doro Approved <br /> The Undersigned h �' <br /> Hereby applies for permission to f� r�«kl� '� �� '�O� �� / �> s /! �.r <br /> At the following location --s Z7 �L�� — <br /> �� , ;:_.,., _ <br /> SKETCH � <br /> IWork fo be donel /`�� y� �D�� ,q D� <br /> � V jl � <br /> � 3 � �u_ �' <br /> � <br /> I 3�1 � _ <br /> � s <br /> _. Exrsr. �lcu� <br /> `_`` �--.E�o*p iNEw Ap017fON <br /> -�`=-`. <br /> To F_XIST• D/hl <br /> � --�-`.� �, <br /> ��j�� —,.,_ ,; <br /> --- __ __ --- <br /> �T—_ '--��—.__---`�__ <br /> �,,�__.�.�_-- <br /> � __``---_` `.__---- -- <br /> _�`'__ <br /> The unde�signed owner hereby agrees to hold and save hormiess the City of Varience Required <br /> Evereit from any and all doims for damages thaf may arise bemuse of the Yes__..._...._. _ _.._ <br /> installation and mointenan<e of the improvement hereto applied for and No _._... . _._ . <br /> furiher agrees to remove same upon no�ice from ihe City and to replace all <br /> public property damaged fnereby. <br /> ^�; � .�� �-�u_ �� <br /> �-- ,z t.�:., .. <br /> i,�^, �Y' qrgnature o�/Applicanf <br /> � /i <br /> ��.�'r 'S ,� � ��,g���� <br /> Address <br /> /y�, r� - / � C %�-. <br /> TelepM1ont Number <br /> -/� - �' Date <br /> • _ � � ->.���_ 8 L / � �2 i� <br /> � Inspecroy�'' SignaNre <br /> Fee <br /> G ����9 <br /> nar. <br /> DEPT. APPROVALS <br /> �� —G.J c�. -":lro. �rz� l�jGf/ <br /> Remrnkt Engineer� <br /> Warer��-- <br /> Sfreef <br /> __ � .1 <br /> Communimfions <br /> Tmffic <br /> Planning <br />