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- - - - <br /> � � �------__ _.__--- - - - - -- �,-- <br /> `� ---- ---- , : _ ._ �- y -- <br /> il� I I , <br /> C;1 ''°' i <br /> Iv � ° ' � I <br /> � �� � ��'.==� 1%=_� � i��^/ V�=I,b';�a ;' <br /> �' � V <br /> � <br /> �' `�Ie � I� <br /> �.i J � <br /> 0o I , ' <br /> � _. - - - � . <br /> <_� ��J - '� r-- '���� - i, _ � � � --� <br /> The undersigned owncn c�reby agrces to hold and zave harmless the City of Variance Kequired <br /> Evereu from any and all daims for damages that may arisc becausc of Ihe Yes__.._.. ...._. _._... <br /> installalion und mainlenonce of thc improvement herelo applied for and No . ._....__ ..__.__. <br /> furlher agrees to remove same upon noti� � from Ihe City and lo reploce all <br /> publit pruperfy damaged Ihereby. <br /> _ a <br /> �� � } . i <br /> �C� � Signature oi IApplimnt <br /> ` �:.�:- <br /> . , _. .. ii�: . - <br /> Address <br /> ' r _ — .. .._7 ./ <br /> Telepho�ie Number <br /> . �/ <br /> / ;� Dafe • <br /> T'� -r*"7 ='�' '��-�—=rr/.��, S <br /> .Inspecfor'e ignafure <br /> /! <br /> Fe� <br /> � � 9 <br /> Dafe <br /> DEPT. APPROVALS <br /> Remarks Engineers v . ` — <br /> Watcr <br /> Strect � <br /> Communicalions _ , � `j � ` � <br /> Traftic <br /> Planning <br />