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SKETCH <br />fWork to be donel <br />__ __ ___ a- <br />W <br />Q <br />� <br />J <br />The undersigned ownen c�reby agrces to hold and zavc harmless 1he City of <br />Everell (rom any and all daimz fo� damages thot mo; arise because of thc <br />instnllation and maiNenance of Ihe improvemenl '.��.�rcU applied for and <br />further agrces ro remove same upon notica iw�� tF� CIi.� and ro replace all <br />public property damaged thereby. <br />i <br />. ,� �. —i <br />�-1.�^ � � •>,,.,..: !_..�. <br />Inspecfor't 5lgfialure � <br />�/ �' ��/� / <br />Dafe � <br />Remarks <br />. <br />i <br />r <br />: <br />. � :-'7 <br />' F. <br />. ,,,,,,,, <br />IPP,'D��Q_. F'���� <br />PROi=E : O:irtlr;AGE <br />Varioncc Required <br />Yes.. _._......._._....... <br />No_ _.. _.... .. ..... _._.. <br />� ��_� • <br />�'j'I �.7/l.GIIr�.�i..wE�'� <br />(�1 Signa ure o Applicanl 1— <br />yy1 � i <br />//, / � 1 <br />_ �fT/%: �.�.�/!= c�i.-" (i� <br />Address <br />�. ��s/- � /�� <br />ielephone Number <br />Dale <br />$ L—// 4� �'�.' <br />Fee <br />�'7 DEPT. APPROVALS <br />Engineer � `-�"�^�`p'y `� `� <br />Water �°^Q <br />Slrect <br />Communiwlions ;•.�,: ., l� �` � � F'„'—� <br />Tratfic <br />Plonning <br />0 <br />