Laserfiche WebLink
Hereby applies for permission tu_ <br />At the following locafion �DO S" /: v�:/c� l� �'�ry � ����� <br />SKETCH <br />IWork to <br />'z <br />W <br />�- <br />� <br />w <br />w <br />J�. <br />GC,. L NeTE: SNarfit� A CiTy <br />; 7�� � TVPe "c"c�2v <br />�Thc undersigned owner hereby agrees to hold and save harmless Ihe City of <br />'� Evemn from any and all claims for damages Ihal may arisc because of Ihe <br />installation and maintenance of the improvemenl hereto applied for and <br />furlher agrees to remove same upon nolicc (rom Ihe Cily and lo replacc all <br />public property damaged Ihereby. <br />��� � i � ��. <br />' � ' r^v •%�'2%� 6 -l>- � <br />Inspecfor's $igna� <br />� �7'r f/EC,�F� 3 i 7/7.� <br />Dale <br />�fill Cli�ifl^LIifP? �C�;f. %^" nrr�• <br />c.,.�•ZuJd <br />Zi �,�I17$ �;Iv'id <br />COii+� '�I7 Ifi Si�fiB(�, <br />� , , .... �. ,. . <br />__ I�A�k1N� � i� <br />�2 <br />ariT �:' <br />�a"' <br />1 �I: ..__ 1 � � <br />..,..�„�_ I .. ._ _� .. . . _"_ �. ; <br />� <br />�-v�---__... � � <br />U <br />,^_s-� ,iN�- <br />/� �rl'' <br />�,JO SGFLI� �='p' <br />,� <br />Variance Required <br />Yes...... <br />No... .. <br />�,��. �� (? (.� o-^. i... '; 1%V� � r <br />r 2.-`� @ �1,� <br />i <br />( � <br />, : �� .�.t,� � . i � � �� %.�---_ <br />� � Signafure c�f Applicanl <br />,i..�L ''(��cX 1�'�ii-llL�•r,,,�t,�4-_ _ <br />' add�e�t <br />�":1--`i -i i ; i <br />Telephone Number <br />Date fJ , <br />• g � / �/� �P <br />� _ ;r ` <br />Fee <br />DEPT/. A'+'PROVALS <br />Engineer;1���'r ��./'�• ��'�''2CJ�'.7Z <br />.�•_ 'T• C� � , � . � �_ <br />Water �-`-- <br />Slreet <br />Communicaliansz'' � � ? "" �� � � Z <br />T�atfi� �l �`: ,�,'� 3- 2 0- 7 � <br />Planning' �� -��/�' % Z <br />°l' 1TG <br />_.- -;�,i;��� AT�f7 <br />�� i � � ri 1� � /�,' [�- � I('r <br />l �� '1;iU�4� t �f'OfF ��'�d� <br />' T10N <br />� <br />