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(Work to be done) <br />�-� � ,.. i ._ - r . <br />i <br />' �1 _ ___. -------- /� 2 <br />tJ � <br />E � ' =1 <br />!' — - —. <br />' . •Z � <br />i3i t2.. -,.t •r.1�c. _", <br />; �. _ � ZCn <br />,� , : <br />� r��. -- � — <br />� � 1 /L ! _ _ <br />r,=, <br />��p <br />i� ,�,: <br />The undersigned owner hereby agrees fo hold and save harmless the City of <br />Everelf from any and ali claims for damages Ihal may arise becaute of tlie <br />�nsfallation and maintenance of fhe improvement hereto applied for and <br />further agrees to remove same upon notice from the Ciiy and to replace all <br />public properly damaged thereby. <br />/ i <br />, � �� <br />«,. � ,�j�.�� � G���' `� <br />/ i ��. <br />i i� <br />r <br />�� e��� �3�.rti�-�-� <br />Ivspecfor' ignafura �i/� <br />/%9�� 9 <br />Date <br />' .1 <br />a' <br />I' � ,;:) <br />Jariunce Renuired <br />7'es...... __.._.. _._ _..... <br />fJo_..._..-_. ..__ _...... <br />c <br />_..` .� �c i � <br />J,, ;=, %pYCo�. _u <br />_ �9i/ f����,rsu/ze �2. <br />F ��r� <br />� / � � <br />:� <br />` Signature o Applicanf � <br />�;��?/Z- .f"PTrr•��� <br />Addrest <br />3� � '_ p�i'��T <br />Telephone Num6er <br />_ lci r �-� - /n,�`} <br />oare <br />�� <br />S �� 5 <br />Fee <br />G-/31/9 <br />DEPi. APPROVALS <br />� � . <br />Engineers �. <br />r, � <br />Water . <br />Street - <br />Communicalions <br />\� <br />Traffic <br />Planning <br />"y i <br />