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�JEREiI. Y,�r�Slt.
<br />Thc Under;igned_ —
<br />fiereby applies for permission fo '. -
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<br />DafB Approved
<br />At ihe following location ' � -
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<br />IV�ork to be donel � ,-;� �•,.--r,
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<br />Thr undcrsigned owner hmeby agrces to hold and :ave harmless Ihe City o!
<br />Evercll from ony and all dnims for damages Ihot moy arise becausc of �hc
<br />installolion and main�cioncc of the improvement hrrelo opplicd for and
<br />furlhur ngrces to rcmovn somc upon noiicc Irom the Ciry nnd lo replacc all
<br />public property dnmaged thcrcby.
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<br />Inspedor'i Signalure
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<br />Dale
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<br />Vorioncc Required
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<br />. �1 $ignalure o/ App�imAf `"
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<br />�'� Address • •^'
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<br />Trlephono Number
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<br />DFPi. APPROVAIS
<br />Enginecrs �_
<br />Walcr '/, , ��.n ..Y
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<br />Communiwlions_�i' � �
<br />Tra(fic—
<br />Pln�nin� _— _—
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