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SKk�CH <br />fWork to be done) <br />e <br />� <br />� <br />Q <br />N <br />n, <br />h <br />The undersigned owner hereby agrces lo hold and savc harmler: Ihe City of <br />Everelt 4rom any and all cloim� iar damoge: that may orise b�ecause oi Ihe <br />installation ond mainlenoncc o( Ihr imprcvemcnl herc:o applicd for and <br />lurlhcr ogrecs fo remove same upon notice Irom the City and lo replacc ell <br />public property demaged thereby. <br />.� i <br />`�7 <br />� �-^^• / ,, <br />(��l�-�'d�i�:- � � [- . _,�•_.-;=-e�.i. <br />Incpeclor'i Sj�alure /� I <br />'�I 5 , ( : �/ <br />Dale ' <br />Remnrki <br />L <br />.s <br />�: <br />� <br />, .,...,,T�� <br />•:r_ <br />� .,�,n-,�cN <br />PrcOVi�C F';" <br />�'f��'� ..". i:.ir,l�'.HGF <br />Variance Required <br />Yes..... .. . _ .. . _. _.... <br />No. _ ....___.. <br />n� /� / � a <br />r� � �/� ,,�/ . <br />:�l J�� Signc�ure o Applicanf <br />;� '� � <br />�, �'" � ' ' <br />Add�eti <br />�3�/=-1 /��-__ <br />Tetaphcne Nmn6cr <br />Daf e <br />s L—/�9�� <br />Feo <br />DEPT. APPROVALS <br />`l /�`���%� . <br />Engineu µ� �/- `--PJI.�'ti'�'S. <br />Wolcr a*`Q <br />Stroet <br />i .')��fi(-.: <br />Communicalions,.y,/-��_ -. / 5,-- , y <br />Traffic <br />Planning <br />?'' <br />r; �sg�a <br />z <br />T:, o a stvi t tn? � <br />�i' �'�i �. <br />Y�""ti�-¢k �C� <br />...M�« .�..vF..< n=.we�-.r4.e:.r�--i+w+e.. �+rr�..... <br />