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,-�.:� � <br /> �z -� _. <br /> The Undersigned - _ Dare Approved <br /> ,^ <br /> Hereby applies for permission to N r.i'r. ; _ +� • <br /> At the following location ' I i'r, ,. r. � i- , 'Y". �2Z� --�9SiN0 �.J s.(,/j� <br /> SKETCH <br /> IWork to be donel <br /> ,+. <br /> )� <br /> I `-- ---- __— --- ------ I <br /> . � � <br /> ,n� <br /> � . <br /> j _ .. <br /> ; � <br /> � <br /> � <br /> - Nnr i: '. , , �, <br /> The undcrsigned owner hereby ag�ees io ho�d and save harmless the City ol Variancc Required <br /> Everell (rom any and all claims for damages thal may arise becau�e of Ihu Yef <br /> inslallation and mairtenance of the improvement herelo opplieJ lor arol No <br /> (urlher agrees lo rcmove same upon not�ce irom Ihe Cily ond to reploce all � � <br /> public property damaged Ihereby. <br /> ���• ���1.�z� <br /> Signalu�e o/ Applicanf <br /> � -u�-s--G-„ <br /> /;.E� �T �UC.I'Fll ��/�121! l�-r-(%� <br /> Addrest <br /> Telephonn Number <br /> ;J.: � � <br /> �D-/ - 70 <br /> Dofa <br /> Inepeclor'� Signafure S N� F,�'� <br /> ,��7� CHfC.CE/J /��.� Fee <br /> Dala <br /> DEPT. APPRO AL� <br /> /y)�`� / <br /> Remarki Engincers y����t�Jl-4�S' //-Z�G/Z <br /> Wa�er I/.ie-�.�f.� lG�:C��"'r: <br /> — S�reel -�� ' � �:' - <br /> Communicali s��l- �!�^.<.•-.. •�..,.- .�. _ _ <br /> Tralfic -,�'� i`. <br /> — --- Planning �/t� <br /> p/o 7 ! . <br /> C=�;1LL E,;;: iP�l- : I� ir�f.. �,l . <br /> �= v- .s�8^�r �yy�,,:�� ���-, ; � , <br /> , _ t, <br />