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The Undersigned _ <br />Hereby applies ior permission lo� <br />� <br />At fhc �ollowing locafion—� <br />SKETCH <br />IWork fo bc donel <br />- �� . <br />. <br />' /: ' <br />� ; - <br />� _� <br />FT<t'i'r{��`.-=�� ClitVl.4�f�. :iLAB <br />iU 8E 1tJSTA�]-E_U AT E�iTGN�� <br />:v <br />�F FU7iJK�---='�',�c�WE���, <br />,� : .- � - —_ <br />; �u..��.. � <br />5-`� �Jz i <br />1- -, <br />. _�� <br />� � <br />� J� <br />.. <br />- -__, ��}�,� <br />�, �� <br />, �!I <br />4a <br />n <br />� <br />The undcrsigned owner hereby agrees to hold and save harmless Ihc City of <br />Everel� from any nnd all cloims ior damages �hal may arise 6ecause of the <br />installotion and mainlenance o( the improvement here�o opplied for and <br />further agrees to remove same upon nolice (rom Ihe City and to replace all <br />public property damaged Ihereby. <br />'��OSPcI ���/ �� <br />Inspecfoi s Signolure <br />�/ 7�/= �' (-i!`_'C K i- 1� t. � 5 i i <br />Dale <br />/ <br />.�" r� �,,. N�/�7 Z _.. ��.i S�c:/!� <br />5 ��� Se� '�i,�<t- <br />� ��im� i� � ,:�;�,,;�j: <br />� 4 Haur� 'atore <br />, ,.�,, , �,� �r'� ' <br />µ.:�t r� k. <br />; VFl�Ve <br />/ Box <br />V <br />�°�//r.;--c--t -<'� <br />� <br />'" </ " �-> t — ,�s <br />Da�e Approved <br />e <br />EXlST'/.�:: C_:J�cG - <br />� !J T 'T� � � , <br />� _; r. W I i h''! �"h�1�V <br />.;,-=^�!�P? <br />� � � . :'�[ �,�rn <br />Variance Required <br />Yes <br />No <br />N "> '�_:.�LE <br />� - r ., <br />' -! � <br />� Signafure o( Applimnf L - <br />i �- <br />/- ' �� 1 %!�� <br />nad�a,: ,, — <br />�, -�� � . �. <br />r —� e> J � i ' � .l <br />Telephone Number <br />f:ngineers <br />warer_ <br />Streel _ <br />S <br />Dafe <br />�� <br />Fee <br />1 <br />DEPT. APPROV�ACS <br />�/ %rL /�.�/t (.^� <br />•� � <br />�`� ,,��Df; h�,R -_. _.�."_� <br />Jr EH DRAI�JAGE <br />� <br />I. _....__ .� -. -.- _ . <br />..« �. <br />