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• � Approved 3y <br /> � � f i � <br /> The Undersigned � �-. VV 1 ( f 1 f�' � I } (`.�� Dote Approved <br /> ,'` , ' � C.CpNC. � / Q�SO \ <br /> i Hereby ��pNlies for permission to :�P )v I � i / -{� �1 � , / 1/✓ I S-E.�'��t'+� M T � Z���- I <br /> � <br /> At the following location- �D� � � � � � !� C .�- (S 2 2 ��'� p� �l p('� <br /> _ ��f- I I C n I bv A �/c� <br /> SKETCH � <br />' (Work to be done) �' I <br />' COLBY Av� , Z � � <br /> : , . <br /> �i <br />� � / <br /> �; <br /> _ ,__ _ <br /> ; _, <br /> , _ <br /> - ----- - <br /> ---- -- . __ -�, <br /> - - __ _ _ - . � <br /> _ l� <br /> -- y J <br /> I �';� 'i�"� 17� Ff— .-. <br /> , �'1 . <br /> i ^ � � <br /> , � <br /> � <br /> � � S �- ' 3 2 � / �v <br /> p U' <br /> i � �� <br /> I � � < <br /> � � � <br />'� ' � � : :�`i <br /> I ' � " <br /> I ^`,: � <br /> ------- i <br /> ;, <br /> NC7T i � �f� Lt�- �:' G �c�o 7�-' 3 d[o�f / <br /> 6P7'6r -' ,�.�`''�' ^ ,�ri 1/.3 /!� ` �� ;'�r,i/� � Qelic, � <br /> The undersigned owner hereby agrees lo hold and save harmless the City of Variance Required <br /> Everelt Irom any and all daims for damoges ihot may arise because o( Ihc Yes . <br /> installalion and mairttenonce of the improvement herefo applied for and No <br /> (urlher ogrees to remove some upon nolice from the Cily ond ro replace all - �� � � � � �� <br /> public property damoge�i ihereby. <br /> APPi�OVCL� ,��r . W , �U ��q�, �C.S,� <br /> Signalure o1 Applicanl <br /> v� �-���. 3 4 I I C�i �u ��FG <br /> CI :r,n;: i :� — - Addrest <br /> q�-�-r' I �11 <br /> ielephone Number <br /> - � - � - 4�) <br /> > Date <br /> ,O �.i �. > �•.� ".-.��..... /� . /� / � <br /> Inspedor;s�Signalure . � $ $� ��J � p�,'�/�/�. <br /> l <br /> � l <br /> •�� � Fce <br /> i '�%r <br /> Dafe <br /> GEPT. APPROVALS <br /> Rrzmarkr ' <br /> Enginccrs— I <br /> Waler r <br /> Sfrcet i <br /> Communicalions �'- ��-� <br /> Traffic-- <br /> Plann�ng ^ , <br /> i <br />