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The Undersigned_L� � <br />�� .2G / �7/ <br />Dale Approved <br />Hereby applies for permission to ����� ����^% r��/%•��� ���h r��"%—��� TO r'-�R6 <br />At the following location ,�� �,'�-/�1/�•��:� ,'`'� �� <br />SKETCH <br />(Work to be donel <br /><, <br />The undenigned owner hereby agrees fo hold and save harmless 1he City of <br />Everelf from any and all claims for damages that may arise because of Ihe <br />inslallafion and naintenance of fhe improvemenl hereto opplied for and <br />further agrees lo remove same upon nolice from fhe City and to replace all <br />public property damaged fhe�eby. <br />Inspeclor's Signafure <br />SiT7.'= C`i�EG.x'6C� � Z•Z—%/ <br />Dafa <br />Remarks <br />�Ro�ort'n N6a1 /°C.G�,vc.. ��t�Et.lr?�.K <br />cd�f3 <br />Water <br />Slreef . <br />Traffic_ <br />Planning <br />Variance Required <br />Yes........_.._.... .... __. <br />No... _....... _. _........... <br />�\ <br />� <br />,�'� � �' - <br />L't,`/' G(.� (��.Z�L`�- —� <br />� Signafure of Applica <br />� . <br />� ���� ,e����t-G�t.a�J CC�v—�, <br />Address <br />�s a, - ,,a, ,,�' <br />ielephnne Number <br />_ . ' � , --, <br />-� �'J �� � , . �, <br />Dafe <br />Fee <br />� <br />