Laserfiche WebLink
Tiie Undersgned_ � <br />Hereby appl�es for permission ro — <br />At the following location '"!1" L' <br />SKETCH <br />IWork to be donel <br />` � :.- <br />%y.� <br />/ ' � 'A�--�.. / / /, { / / �� � i • �� <br />'� � � � �/ �c� <br />� -_�� i �% 18' <br />— � I <br />i �: : <br />; �, o <br />The undersigned ownen c�reby agrres b hold and savc harmless the Cily of <br />Evercll fwm any ond all daims for dama3cs tFnt may ari:c becouse o( Ihe <br />installation and maiNenan<e of ihc improvement heroto opplicd (or and <br />further agrees ro remove same upon no�ice {rom the City and ro repioce all <br />puH!ic property damaged Ihereby. % <br />� . .< <br />I1 ,r.' '/j;. <br />�' 2� U° r: <br />° ,rl `r'�"'i .' <br />'r m <br />�� <<, ✓ • <br />. i', ` <br />/ <br />�' .Y!-r�'-.'.' `�i� <br />Inspector'r%5ignalure � <br />/ <br />- �� <br />--�'— -- <br />Dole <br />Date Approved <br />Variancc Required <br />Ycs .._ . _. _. . . _. <br />No_.. . ._ . . <br />$ <br />Signalure ol Applican/ <br />Address <br />Tefephone Nun,ber <br />Da:e <br />Fcc <br />DEP7. APPROVALS <br />/ j � �—� ) <br />� <br />Enginee - ' ��� �n <br />f� —�� <br />Watcr ` _ <br />Slrec' <br />� <br />CommunimYans Y* - " <br />Troffic <br />Plonning <br />N <br />