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SKETCI i <br />IWork to bc donel <br />,\ <br />DULI_ AVF_, <br />i._,�Vp. <br />Tl+c undcrsigned owncn c�reby agrces to hold ar.d save harmless Ihe Cily of <br />[verett irom any ond all claia�s for damages thal may arise because of the <br />installation and maintenancc o( the improvemenl hcreto applied (or and <br />furthcr ogrces to remove samc upon noticc from Ihc City and to replace all <br />public property damaged th•.•eby. <br />� <br />' ' � L <br />� i: � <br />; � - ij �, �'-'�t�,t .i��L , <br />Inspedor': Signalur,v <br />'�ITE C.�%l6c:t�� `5�9�i2 _ <br />Dale <br />Remarks <br />... �,....., i:�,..,1:. <br />nslruction is slarted. <br />a <br />i� <br />z <br />J <br />N <br />4 <br />4 <br />� f� <br />Variancc Required <br />Ycs .._ _. _.._. _. _ .. <br />No.__._._....__ .... <br />�'� �lz�� _ <br />Signofure of Applicanf <br />.3c'� Sr — / y O . S �,i � �;`,.�. =-C / <br />Address <br />'% y3— 3 �-/ �i. <br />ielephone Number <br />/ 7- = L- <br />i Dafe <br />�C. � <br />) c; .� ' f �� �i`�.4-i/� <br />--� J i i — <br />,otli 'P.'`.i;i� <br />Li!"��:? :"117H \ti'ATER � <br />f""'.. :.''.i :i LIK� <br />i . � . : .. '"i Of2c EXCAVA710h <br />� . ____ECC__. . <br />DEPT. APPROVALS <br />^, _� , <br />Engincen� ���� �'�J���� <br />Waicr /� -) �• <br />S�fCCI �.+/'� r a.� ., I.S /�I..1-� -_. i- I <br />I <br />Planninf <br />..:'... � ..., <br />�r n.:e <br />. I����S..i 1.�� U��1��Y:\4l. <br />�..__,._._._..._ .- <br />