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IWork to be <br />/ <br />� T—�f --7 <br />� "- �.o' 1 <br />E �E�R EEI� <br />2 <br />The undcrsigned owner hereby agrees to hold and save harmless thc City of <br />Evereft from any �nd all claims fo: damages tl�a1 may arise because of ihe <br />in:lallation and maintenance of the improvemenl hereto applicd for and <br />further agrees lo remove same upon nulice from the Cify and lo replace all <br />public properly damaged Ihereby. <br />/`'�" <br />� <br />✓ <br />Si3nalure <br />/lJ0 r�/���'' � <br />,�/ T/L Ci�/J'f,�IC!2 �% 9/ � %/ <br />�ar� <br />��� � _�v��- <br />!��7 �, <br />i <br />—t_( <br />6aoz , <br />-- � <br />�---�_.I <br />DUE 7p Wip�rNUJG oc MAG��or/ „re <br />Pltu'g A2r �3FiNG MDUr-_p ��,�.�p Nrw <br />�L.. by Iv�: 3G'Pnory �, <br />3'1': ° <br />.�oll l;ngineanng DepL 25d�Yalia � t�S7 i C <br />24 Hours before C:!�CK WITH WATER <br />c.onstruction is started, U'_;�t. FOR WATER LINE <br />I.r �',TIbNS E�EPOkE EXCAVATION <br />G <br />b <br />� <br />� <br />Q <br />� <br />wQY <br />� <br />Variancc Required <br />Yes .... <br />No...... <br />i <br />- , � ..- � � <br />rGi`i';` �.�t� �-rv � <br />Signafure of AppfTcanl <br />Co G`�� �- L-,4.,tiy,,.:r...� /...%.:�-�J <br />J' <br />Address <br />iefephone Numoer <br />� - a'- 7Z- <br />oare <br />s No Fc� <br />Fe <br />�� -�y�--��1 <br />DEPT. APPROVALS <br />Enginee <br />� '�`y/�-iL <br />-,i�',-Wafef y .?. (9 � '%'? I' � <br />Slreet —�-�— ------- — — - ----- <br />Communicalions i'�-"�/Y2ri-�•-<<:�'... /�.'--- <br />Tmffic :�il.sct=.-�C;._ ,� .. .,ii� i � _ <br />Planning �y �� <br />i�.---- <br />� PROVIDE FOR <br />� PRUPER ORAINAGE <br />0 <br />