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The Undersigned - <br />Hereby applies lor permission fo <br />Af rhe foliowing bmtion � � <br />SKC.TCH <br />IWork lo be done! <br />a <br />���� /�, , <br />�=.r� ae FoR_.__J <br />'F' � �jRi�.ta.AGE <br />, 1 �. r �•` !i <br />� �._,,,i <br />• t`GT� ' y <br />p4`cr. v��N wnTra <br />r� ���r.i� , „"r • � <br />Sil. i'1 .i1' �va . 1 � • ' . <br />Lc�,.. <br />B�o�v �.'�, o,� <br />Thc undersigned owner hereEy agrces to hold and save harmless the Cily of <br />EveroO (rom any and all daims for damages ihal may orise becouse of the <br />insfallation and mainlenancc o( Ihe improvemenl herefo applied for ond <br />(urlher agrees lo remove same upon nolice from the Cily ond lo reploce all <br />pu6lic proper�y domaged Ihe-eby. <br />> � <br />� ��—, y.�,�. [ . % L/J! <br />,�G �. � <br />� <br />c :'/i <br />Inspecfor's Si nalure � <br />/ % <br />/ ! <br />, . � • , i <br />Dale <br />�2emorks <br />� <br />/ <br />_' <br />L') <br />7j <br />Vanance Required <br />Yes <br />rio <br />Signalure ol ApplimN <br />Add�e�s <br />Telephone Number <br />Dafo <br />_ E �� ��y�'� <br />Fee <br />0 <br />� <br />�EPT. APPROVALS <br />�"��.r' <br />En�jinccrs � ' ���_ ' <br />Walcr �6�., .-. � � � <br />Streel - , ti.��— <br />� ,r/ <br />Communimlions,.,:,_._._._� �.T—._._ <br />Traflic _ <br />Planning <br />