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��.���,-� � <br />-- , <br />The undersigned owner hereby agrees to hold and save harmless the Cily of <br />F•=ret1 from any and all claims for damagc�s that may arise because of ihe <br />installation and maintenance of the improvemenf hereto applied for and <br />further agrees fo remove same upon notice from the City and to replace nll <br />public properly damaged 'hereby. <br />$ignafure <br />ri6-� CtiEc,e� 3/r/�o <br />Dafe <br />�� <br />V <br />Variance Required <br />Yes_....._ <br />No__ ... <br />� . <br />�i_�: ;:<•�; . - �- � <br />Signalure ol Applicanf � <br />- _ - :; i . .1.. <br />Addre;s Y <br />, _ , .5-,r�� . , <br />L �ielephone Number <br />;,� <br />i..�' _ � , '7�J <br />' na�e <br />b <br />Fee <br />DEPT. nPPROVALS <br />Engineers � <br />Waler � �� <br />Streef <br />� ���. <br />Communicalions • <br />Traffic ' <br />Planning `^�/� � <br />Se�t1c.,- !a G-- <br />