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The Undersigned. �- J . — � ..— �/f.�_.. ,=.-.,_ ` ;- — � � , <br /> ate A pioved <br /> Hereby applies for permission o =/.% �:��` F' ,�i?'f=11•�iT _ _ - .-, � , ,s- , �, / <br /> _ � . ., <br /> _ ..+i'`7 � '�- �/ i�.�^-�.tJ.C�.G..�l / <br /> i <br /> At ihe following location -�.��� �- �" : -�%' _��.C.� •"'� <br /> SKETCH <br /> IWork to be done) <br /> , _ . . _ ^.� _ ,_ T <br /> �i'E1.9=%'c �'f='t,i'LACE � ' <br /> cK/ST, O�il/E. s BUGH;�:=`iQ j 5/DE✓✓,' _ ,- - -- <br /> -- <br /> — - - :. <br /> ...._ _ _�__ _ J _�_�__" I �i. <br /> q,o: _ <br /> , �����. U��� �4����, <br /> _ o '.;�., .�. �,���. � � j <br /> : �' s� 1702 � � � <br /> -;. '� �', , <br /> =�=� � ' ; <br /> � �� __ � Q :I �� <br /> I ; � ;� i scA �_ /'=4-O <br /> I � � � � <br /> i i� � i � <br /> I , p , �� <br /> IN � `II � I <br /> i � o I I I <br /> I � � � • \ <br /> The undersigned owner hereby agrees to hold and save harmless the Cify of Variance Required <br /> Everetf from any and all claims for damages thal may arise because of the <br /> installation and mainfenance of Ihc improvemenf herefo applied for and Yes__ ...._..___...__. <br /> further agrees fo remove same upon nolice from the Cily and to reploce all No___..._............_... <br /> public property damaged thereby. <br /> i• <br /> ,h� (1�. � � � ��`, � � � <br /> . , , <br /> �_ �:i..: ��_ � � �- � - <br /> ,. , Y� .. .� �( _ _ , j �J"'�..7r_ � �,�C �i��� c Ci,�.:i'<_' �C <br /> '� . �' <br /> �=---fY��J�.-��-���� <br /> Signa�ure of Applimnt <br /> ' -' c J / <br /> � �* „ /� _ � ' `c`-c.,-�-L����-L�.��� <br /> �' ' ' �- Address <br /> /7/ Y - "� Y f� � - <br /> Telephone Number <br /> /`�Af� I�� /97�, <br /> Dafe <br /> Inspeclor's Signalure § <br /> S i Tr /-<,=r',e-.=/J `S��/J�) Fcc <br /> Dafe <br /> DEP7. APPROVALS <br /> Remarks — _���. � �—� - � <br /> Enginecrs'_ _ �S��C <br /> h Waler � � �/%� 'v�r�> <br /> � '< <br /> Sfreel— -I: %1�`�7'v[ � <br /> Communicalions ��/--u�,-,�a;=-,-�-�� <br /> Tra(fic_ ���r%� <br /> Planning `��� <br /> �c,<:.,- '�,�' �l� ,,f��—.- <br />!:SvtlR YfY1tl[3'2�i1i4}1llYG1�341i116iW0YiG��•�.�•��- • — ErMtiATia"id"i�}9RI�C41YID6XRmt �R�'tiii� M.CM`m_1��':tiP�SYT.lSat6�i\�tlCR2��tffiHIC:6'Mr1P4�YSmPfei�bw� w�lvs.df^XAMLVS <br />