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The Undersigned�_ <br />Hereby applies for permission <br />At the following locaiion <br />SKETCH <br />IWork to be donel <br />/5 <br />/� <br />_ � , .�r.. <br />,_ . . ��: !... � <br />E�isT,•,. , ^ <br />,� � <br />GUY W'R.= <br />� � � � <br />— --- --- --_-:— — ---� <br />O irL A /�Gr�1�l f1 �/�il�LJl-� <br />The undcrsigned owncr hereby agrees lo hold and savc hormless Ihe City of <br />EvereR from any and all daims for damages that may arise because o( thc <br />installation and maiNenance of Ihe impro�+�menl hemto applied for and <br />forlher agrees lo remove same upon nolice iram the Cily and �o reploce all <br />public properly damaged thereby. <br />Inspedor's Signalure <br />Siri=C`:�/i=C'F_i� 6 i• � �� <br />Dafe <br />/7 <br />'Z' 230 7 <br />o' ie' <br />� <br />/6 <br />/" /� ,� ,, . •� � <br />/. �_. ` ti•�' ��� �� <br />, ' Dale F.pproved <br />a: Pi�A� r p,e � vc uiA <br />� <br />/ D::�: <br />1�RIl/.�=W�,�S� 7�7 C'Lc.Y�� <br />_Fxisriiv� GvY By� .=' <br />Variancc Required <br />Ycs <br />No <br />/�� /i- <br />'C_.fi�✓`�� �' e-�: `� L <br />Signafure of Applimnl <br />� % t".o' ��f�7�C N / �� r ��/�c k�/Ae�. <br />Address <br />'���?� � r' �� � <br />Telephone Number <br />�1 � C 7C-• <br />Dafc <br />S ,i 4'' �yiG. <br />Fee <br />DEPT. APPROVALS <br />Enginecrs L� � �/�' ��/��%J <br />Wolcr � " ' <br />Strcet <br />�1. ���u�� _,,.;: .-.: �i�z <br />Cammunicalions _' � <br />Traffic_ �~ <br />Planning _ . �C�%� <br />