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The UndersiGned � 1�= ' ` � =- <br />� Approvec G� <br />_ ;�'//?f/ �.'. ��l�i��V <br />Date Approved <br />Hereby applies for permission fo � 0� `� T � r' '' r"Y� �-� � r= . C S ivJ F'F: -'�: i�- �� � s" ���� - <br />_f-�GLF_% 'l �r-c�oi::C�-'_ S/JSTHCL l�C-!nl ^_U'zB. <br />At the following location � G U- !? i?0 k L!{l A y [� �' /'! 570QE <br />SKETCH � <br />(Work to be donel j <br />, <br />; �, . <br />i .�� � <br />--_—.. c� ,. <br />t? j ' !'' <br />,; ,: <br />.� <br />� �? �. <br />�o <br />. N <br />�EX/ST/NG , <br />D�yV c— <br />�� �� <br />ol ��4P��" � <br />� <br />A� <br />�� <br />. <br />Gp �� <br />ENqcl1 <br />� <br />,:� � � r_ y y., _:�, �-a, <br />i�� a II SNy 'r� 5'� <br />a; 4 1. �-J t��� <br />tv ! i <br />��'��' .� .. ,'J �.i <br />The undersigned owner hereby agrces lo hold and save harmless fhe City of <br />Everefl from ony ond ol� daims for damages thal may arise because of the <br />installalion and mainlenance of the improvement hcrelo applied for ond <br />fvrther ogrees fo remove some upon nolice irom Ihe City ond �o replace all <br />public property damaged Ihereby. <br />� � , ,'. , . , 7 <br />� _ � �� �i .vi'��'�� �i� `� � � / � <br />Inspedor's Signalu(e <br />. 5 /TF C�./f=G"n'El� �,2 �'Z <br />Dale <br />,�. <br />+.}`.,:) <br />�'..f.n� <br />Variance Required <br />Yes._. _.__._.._ .... <br />No <br />, �( / <br />G �c /� <br />Signature ol Applimnt <br />/�'.� �y / /�' <br />/ hJ � / J �� /_ J j- I" ( . � <br />Address <br />/I � �j '- % / � / <br />Telephane Number <br />5—/G-7z— <br />Dafe <br />��' F���- <br />Fec <br />DEPi._ APPROVALS� <br />i <br />En gi ncef5 �� �'���N <br />Waler � T' S — / 8 � <br />Slreel " - <br />Comm��� �i�o. �c ,f'—I�j—TZ <br />Tmffic C%{ �'� S' �l -; : <br />Planning �.'�' <br />__.. _..._.._.___. ._. <br />Vi�C FOR { • P;M�i".:. <br />LJII il���. I�I:', Ilb�� A.IJ�U����'7 <br />r E,2 DRAiNAGF i9 Ilours bcfere CEtEC!c Y i_�" `, <br />DEPT. f Ofi ':. . <br />construction is started. �����io��;; � ��� <br />'___— <br />