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1 <br />3L l�2 J <br />'�—�!/ G G �J i1/ <br />1I � <br />Zh �`�i� I ••� ���',I <br />6 'a.'. <br />V' �' <br />.-� ' [�•./„ <br />(. , <br />�'�_'___.--' <br />.� A. 'l :� <br />,4SP. �ati'c� A.'c�/lvY_. <br />The undersigned owner horcby agrr.es to hold and savc hormless Ihe Cily of <br />EvmMt Irom any and a�l claims for damages thot may arise 6ecause of Ihe <br />installotion and mainlenancc of the improvemont hcreto applir.d for and <br />f�rther agrees lo remove same upon nolice fmm Ihe Cily and to replcc.^. all <br />public properly damaged Ihcreby. <br />� � <br />� J <br />��..,.•i' i. . <br />G� <br />,.� �l ,` � <br />. �7�-v4,•J- `-+-� . <br />� I spedor'r ignaNre r' -- <br />.. <br />� /� - <br />Dato <br />..'� Lr;��,.'" <br />v, <br />�. <br />T`�+ <br />Nn <br />♦ <br />Variancc Required <br />Ycs.... ......... _._.... <br />No. . _.__.. . ___.. <br />, ;'j,� <br />� �r <br />-�l.�,�i��. 'i:tl�cq,:, ��r��;%(7 <br />Signalure of Applicanf �i <br />add��:t � <br />ielephone Number <br />Date <br />s I / -:�" � _ , : -, �• ,; <br />,•.�1. ,. •.,.,..:;' <br />Fee - . � <br />. ` <', � <br />1'r <br />DEPT. APPROVALS <br />� n -C: 1 . <br />V�gmecrs "'v"� <br />er� <br />Sireet <br />Communicalions �,". •'� � ` .-+ . <br />Tralfic � •.! �, �'` r �;��� <br />PlannS'�� � <br />