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sKercH <br />IWork to be doncl <br />U <br />� <br />S:_ —' _ <br />f ,L . �_ � C� ,=. <br />a <br />� G�l caN.r. � -,;�-� 'r�� , <br />� FF�OM, �? Dn/ �V.��PGP r �` <br />%S rr' • 7- <br />5Gd!-c= <br />� n(pC-)� <br />7 � T:; <br />?� •=- . � ' _�� ,/� <br />� <br />c ;,'l'a,•,. <br />,. <br />r,/. , ;' ' <br />D - /I <br />% Y' `V � � <br />( _,l�S�! G J;'��''� , . . ' .�! <br />� <br />`� I <br />8 1;�, ` r v '. <br />/ �--�5.=� .�.� � �/ r <br />t15P<14L T CO �V�'. ��.c'/ ;- c= � <br />Thc undcrsigned owncr hereby agrces lo hold and savc harmless the Cily of <br />Everell from any and all daims for damages thal may arisc becausc of Ihe <br />installation and mainlenance o( Ihc improvement hereto applied ior and <br />fu�li�er agrec: lo remove same upon nofice from thc City and lo replace all <br />poblic property damaged fhereby. <br />Inspecfor'a $ignalure � - <br />i � <br />ij � i <br />/ ,: <br />Date <br />Remcrks <br />,- , <br />i,�•, <br />w . a �.•_� ,:y::.:ti,�'_'`� <br />�r��ti! F'; � <br />� YT. C"d.t'f3. <br />(.. <br />! <br />� <br />.;'/ . 'i1/r"' ,.. . V"�., <br />, . �.�., ,_ �'�'. - <br />Variancc Required <br />Yes.. _. _........._ _. _..... <br />No___......._........._.. <br />/ \ <br />�: , � �� <br />�/L�G/�'�/> �:.,<'-2i F-'YC__-ti�_ <br />$ignalure ol Applicanl <br />/nO 6't'!�/'.f.�c: d`:-.� <br />C+ c�LCc=VV � l'��iJ�'.l. <br />add,e,t <br />sid E � •r�d�� <br />Tclephone Number <br />i <br />�� � `l!�G:• ,i <br />Dale 1 S, n- .,. <br />� <br />Fee <br />DEPT. APPROVALS <br />Engineers-- ` .� <br />"`-�� <br />� Waler � -P <br />Streel��'=-•; �' �� <br />� Communicalion3_�_��__,-r-!���%�'' -� <br />Traffic UIi� �"s�"%' A'-/S-L9 <br />oi___:_... �/. . � '. <br />-r�S �ii%��zr Va/✓�� t�us� b�.Y:�ised <br />�e.tvrc �uvr� , \a��J7�/-�i��� <br />Co-,�� �"— Y %�� .,-��-j�/s - ��, � _,r, v . 1. � <br />`�O.V_f;'�.� L_u.�.a-c"- '(�'. T,-,- �� � <br />�� - _" /S. L- 9 - � c� % � `- . <br />