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Here!;y appPes for permission to_ "�" " __ - � <br />At the following location �'' �'i ``f' �- `�-'" �- %%� � <br />SKETCH — <br />IWork to be donel <br />�_ .-�, i� _ ! I I <br />C�'I� . <br />, __ _ - _: . - - , ;� <br />xqi � <br />�•, .:a' <br />The undcrsigned owner hereby agrecs lo hold ond savc harmless Ihc City o( Voriancc Required <br />EverMt irom ony and oll daims for domages thct may orise because af the Yes __.._._. ...._.. <br />installation and ma�ntenancc of �hc improvement hereto applicd for ard No <br />f�;ther agrees lo remove tame upon nmice (rom the Cily enc to repl�ce all �� �--� <br />pu6lic properly damaged Ihcreby. <br />Inspeclor's $ic�nafure <br />�Sir� Cr/6C.�r p 9�i�i:: <br />Dale <br />� � � � <br />���� <br />� 3��/ <br />�.,�� -�� R ►� ,T= � <br />.._ i <br />) -� :'� � . <br />:. <br />$ignolure of Applimnf <br />Address <br />ielephone Number <br />Dafe <br />$ / <br />Fec <br />DEPT. APPROVALS <br />En�inecr5 '" 9/� /�`-'— <br />Water — � <br />Slreef -� ' � r��_ <br />Communications �C' .l r.t7' �c�- _-- <br />.'v,�. :.�:'�' }f ^ ! ` <br />Tra(fi[ _ - ' <br />Planning �f' � <br />