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fi �. r�� V/; v G <br />CdTC.f� <br />,2E,�v1 � v�,�,� �r'f <br />E'k/5'• %--f• _� <br />.� �l� �ii^ . �L' :�i/:�� .L��-_ .r <br />`c------: � � <br />. 7/ — / i <br />i �S• �__ / <br />� � ,r/ Ifk'�h tdf'-�+' �Yt �Yg,'// ' ;af �_'— <br />S � �� 1 1/r= !//� <br />L/c�H'T <br />%.rv-�oCi� <br />._`. /l, i � .'r�� f . <br />TD <br />F�1�� • • <br />co�vsT. cnn�c, c��f' <br />,C�A//V/�: 1 ,_,; ,�,, ,� <br />„ ,_ <br />The undcrsigned owner hereby agrees to hold and save harmless thc City of <br />Everell from any and all claims for damages Ihat may arise because of the <br />insfallation ❑nd mai�lenance of Ihe improvement heretu applied �or and <br />turlher ogrees to rcmove samc upon notice from the City and fo replare all <br />pu6lic properly domaged thereby. <br />. c�: <br />..a�)�.' <br />Inspeclor's Signalure <br />���� 4����0 <br />Dale <br />/ /� � /�� ��'l�,'�� '` <br />/i. 1� /,,';�� ��. '-'n-i�;r`!' � <br />�. <br />?A' <br />�Y✓TE� ��� <br />�,r1,e.'UF!`7E.%'1r /�t1 f':/��5:" <br />lD,f. \ /.ft.lC: f:� uF'G'" ;`r�r:iT• <br />I <br />� E Ta P F_ �. <br />=� Q T Dl,c.�/��r I,�>: <br />To C�' �'Uk�L7;.IGY <br />� � i� <br />� �f' <br />��. <br />� J / �.,, c�o, <br />cen it, <br />Variontc Required <br />Ycs ........ _ .. _ _.. _. _..... <br />No............................ <br />(�'tai�:•:t'/..,.,�/ (�C�� ��% � ' <br />r <br />. 1 ,-'i � / /. _ <br />� ='C i , ,� LCL: c..<<.� _'� `� �� <br />�u.•e of Applicanl <br />��� Q, � �Y� a' ��i, � — .l �: /-_ <br />� Address ,` ' /t - <br />�, - � , � �. <br />,�_ <br />ielephone Number <br />�,,J <br />�; — _ <br />Dale <br />� !-� — �`�lc' � � �.'• 50 �-'`�. <br />Fee <br />DEPT. APPROVALS <br />Planning <br />