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� �� <br />'.)'}— _ `+\ �—.'r, Dale Appwved <br />The Underigned��-' .�_.—_ ` _� ' ' -- --- <br />r <br />`;.-.�}- �. �� '-�1.�U. �•- <br />Hereby �pplies fot permission fo ' — — <br />At fhe followii� location_ t � '� =—'`�'. � 't ,} � � "",- ' <br />g � ---�--- <br />(Work tl be donel <br />1..0 ( ✓ /_ -- <br />��� <br />� <br />� \ / <br />\ i . <br />\/ . <br />� .-- <br />..�/:r : ��- <br />,� f. � . <br />The un�lersipned ov�ner hereby ogrecs lo hold and sare liormless Ihe City ol <br />EvereH from any and all doims lor damopes Ihal may arise hecause of Ihe <br />in:lallalion and main�enonce o( the improvemenl he�eto a�plied (or and <br />IuNher agrees b rom�v± same upon nolice Imm �he Ciry and lo replace oll <br />public property dnmagey Ihereby. <br />DRIVEWAY SECTION <br />NO SCALE <br />� ��� � � <br />a <br />� � <br />�I_UP <br />���-------- '�3Q •l <br />_�afi.'.�C—�..� ��'�,�,> <br />, {� <br />Inspacfort Signofure i y(,�/,�: �' (�7i�•�i "�n' � ('`"5 <br />�I.d v�. , <br />.st�._L.i..�i�' - " <br />_�_'_ <br />Date <br />Remark: <br />��il I I;; �r,P��ir <br />1 <br />�. <br />r <br />r ,. �, :;�'„!.i. <br />PT. FI�R IYATER UNF <br />..P, � ..'��.� .. . .. <br />• (' , <br />N� <br />r <br />r ;_� � - � , <br />h �,_ <br />.vc r.t. <br />�X; s %�. ��; � � , � _ ; . . <br />� <br />�3.��7N <.«/O�;")G- ������ ��' <br />.., c-r- �-i--.. <br />' �} r U <br />Vmionce Reyuiied <br />Ycs <br />No <br />0 <br />�. <br />_ „'`a�� _ '� � c'l-G�,.>-� ---�,� <br />� <br />�� � � '. '- .' �.:_ t,� �"'.l: <br />$ignolure ol Applicqhl <br />•- " ,. ' �= ��: <br />". - - , <br />Address � � � � ' r � -, �'1_,. � <br />1, , '.- , �- ' <br />Telephone Number <br />__ •�s • <br />Dale <br />� � <br />S ��_, — L�.�� <br />l „ <br />i ,I, 11!-rc.c� Feo . . <br />� 5 -13- �y �, �4y S',l <br />DEPT. APPROVALS <br />Enginccrs <br />�Dn.. i�,. �� = �'l- 7 �I <br />Waler�_ -'' 11,'•�_�-,�' - <br />SIreN � ; /� �� . <br />Communicali =� <br />Traffic <br />Plonni — �"`� �`�• <br />�,: <br />1'rL!i _.:t:�i�' <br />�, �_..�....... ._...._.�.�- _ <br />r <br />