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; <br /> �-- --_.--__ _.... . . . .. <br /> I _.. _ <br /> _ _ - -- <br /> i ; . i ; i ' <br /> � -�:n�: � <br /> ' CH=�� � '.�;n <br /> I DC � . �.,� <br /> I LG�.. ,. _ � '^.n.VATIQ�d <br /> � �� _, _ <br /> I � <br /> I L— <br /> 7� <br /> - --' ------—----_----- <br /> _ _ _ ___...----- ---- _ -------- [,� <br /> -�_:l� /'� � .4SP. �'�.r:/ !�;_;1-'.s�, <br /> �; - — _ <br /> r J/T'�� �'�/� �'1�' � , -;� __ <br /> Thc undcrsigned owner hereby a�rees lo hold and save harmless Ihe City of Variance Required <br /> Everelt from any and all claim. for damages thal may arise because of ihe Yes.............._._.._..... <br /> installotion and maintenance al the improvement herelo opplicd ior and No__..... ..__............ <br /> (urlher agrees to remove same upon nolice from the Ciry and to replace all <br /> public property damaged Ihereby. <br /> Signafure a( Applitanf <br /> � Address <br /> L� <br /> �l <br /> Telephone Number <br /> �:� /` Dale <br /> r i .. ) � / <br /> '�,lt'7�7'Zl �'- �=�'�z-4Y�'�f <br /> Inspeclor�s�.�gnafure � S <br /> �/ � / � — Fce <br /> Dale <br /> DEPT. APPROVALS <br /> Remarks Engineers "•� <br /> Walcr � � <br /> Slrect ,-,��/`1�.i-.. <br /> Comm � � ti" <br /> Traffic <br /> Planning <br />