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EVERrTT, �Vr�SH. Appro�ed By
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<br /> The Und2rsigned_ ' rn��7 D �D�� Datc Approved
<br /> Hereby opplies for permission fo r"�,�<", i r-� ,1 ;�;." y .:;•i ' �:� , � ;� ;_
<br /> �.�cor_ i� Tcil�" <+ �h'/,f)='^- PhTJY
<br /> At the following location ,�/a- �- �^;- ` � �v'=
<br /> SKETCH �1eiE. PR(.F�BRICATEL CIFLrLR �-.G ]( 3� y
<br /> "•N�GH ST6cL =7.;e�E nETP.L SIDr�!�: ,'-..,
<br /> (Work to be donel
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<br /> The undersigned owner hereby ogrees to hold cnd save harmless �he City of Variance Required
<br /> i, Evcrell from any and oll cloims for damages Ihat may arise bemu:e of the �
<br /> Yes_ .__......._....
<br />� inslallaiion nnd mainlenance of the improvemenl hereto applicd for and - -
<br /> furlher agrees to remove same upon noiice from the Cify and fo replace all No. ...._._........_... ..
<br /> pu6lic properly damaged thereby. -._j{�� j; I
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<br />- TE A�O/�E COND�T�ONJ ifAv� ��;'�.;{;�G�� �� . �_.1 :.
<br /> BL�EN REy/EI.�VEO bV/TlS� 7'H� Signofure ol Applicanl
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<br /> Telephone Number
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<br /> Date
<br /> Inspecfor's $ignafure $ �� �- �_ � .
<br /> Fee
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<br /> DEPT. APPROVALS
<br /> .•����_� �c.,.--�� -�°� L iTr C�liiL/G/L �,�-�i� /�, - . / ,
<br /> Remarks ' Engineers `C`L'`'lc..L //'�1 %7/
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<br /> Wafcr f _
<br /> Street :.�- � .,'� .��.+
<br /> Communicotioni '"�=' � �
<br /> Traffic �� �„ � - �
<br /> Planning � �"h�
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<br /> E C:II Engineering i':pL �:�� �_ . .
<br />'` 24 Hours befnre
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